SLO ambulance charges second highest in state
August 10, 2009
By KAREN VELIE
San Luis Ambulance service charges, currently under review for another rate increase, have soared over the past five years to one of the highest rates in the state.
In 2003, the San Luis Obispo Ambulance base rate for a trip to a hospital increased from $664 to $828. Then in 2004, those charges soared to $1,041 when county health officials approved an 11 percent rate increase.
Currently, the company charges a base rate of $1,877. In addition to the minimum charge, riders are also billed for travel at $19 per mile, oxygen, supplies, and equipment.
A few months ago, San Luis Ambulance Service transported a county resident who had fallen and broken his arm to Sierra Vista Hospital in San Luis Obispo. His private insurance provider covered only $2,000 of the $2,855 bill.
In another instance, a privately insured south county man was charged more than $1,000 out of his own pocket because of claims that the charges were excessive.
The average charge for ambulance services in California is $900 per trip. Ambulance companies incur out of pocket expenses of approximately $600 per transport.
While the bulk of county residents rely on San Luis Ambulance, in Cambria the service is operated by the Cambria Community Healthcare District. The public agency charges a base rate of $1,300 per transport.
Typically, lower-income areas charge more for ambulance services due to Medi-Cal reimbursement rates and non-pays (which are indigents and others that cannot pay). Medi-Cal pays only $110 and Medicare pays $582 per trip, leaving those with private insurance and no insurance to make up the difference.
In Merced, a city in which 37 percent of all ambulance riders are on Medi-Cal, only 20 percent of riders pay their fair share. Kraig Riggs, the owner of the Riggs Ambulance Service in Merced, in an attempt to force the state to comply with federal laws that require states to pay their fair share, filed a lawsuit against the state of California that is currently winding its way through the courts.
“We are mandated to respond and required to treat,” Riggs said. “We are in a world of hurt (because of the shortfall in revenues).”
According to Riggs, in areas with large numbers of unemployed, illegal immigrants, and Medi-Cal recipients, ambulance services are forced to shift the costs to riders with private insurance as well as the uninsured. If his suit is successful, Riggs said he is likely to lower his rates.
“If everyone paid their fair share of costs, I would be happy to charge $675 per trip” Riggs added. “As it is, we charge $1,400.”
In San Luis Obispo County, 10 percent of riders are on Medi-Cal and 38 percent pay San Luis Ambulance’s full rate.
Frank Kelton, the owner of San Luis Ambulance, points to the county’s low volume and unusually high first responder fees (costing Kelton more than $700,000 per year) as the reasons he is forced to charge the unusually high rates. He does not expect a change in regulations to affect his charges.
Aside from Monterey County, San Luis Ambulance has the highest rates in the state. In Monterey the contracted ambulance service provider pulled out suddenly leaving the county to sign a short term contract with American Medical Response (AMR) at a temporarily higher base rate while the county accepts bids for a long term transport provider. Charges soared from $1,298 in 2008 to a current base rate of $2,098 per transport.
“We are generally reimbursed for 50 out of every 100 transports we provide,” said AMR (the largest ambulance service provider in the country) spokesperson Jason Sorrick. “In Monterey County we have a high percentage of fixed reimbursement with Medicare being 39 percent of our pay mix and Medi-Cal at 15 percent. This is much higher than most California counties and is due to our high retirement rate and immigrant population.
In a letter from Kelton to County of San Luis Obispo Health Agency Director Greg Thomas in 2006, Kelton wrote his reason for increasing rates which included purchasing new ambulances and EKG monitors, moving to a new office, and upgrading their computer billing system.
If approved by the county, San Luis Ambulance rates for transport are projected to increase in October, Kelton added.
2008 Ground Ambulance Rate Survey (base rate), according to the California Emergency Medical Services Authority:
San Benito $905
San Francisco $893
Santa Barbara $1,391
Santa Cruz $1,036
Factors that determine charges, according to AMR:
* Response time requirements set by the county, seven minutes or longer. The more the clock goes down, the greater the operating costs as it requires more unit hours in the system.
* Rural or urban, road access, two lanes, major freeway.
* Required equipment on the rigs, as set by the county.
* Payer mix, high number of insured or low number.
* Labor costs for location.
* Commercial real-estate costs must have an operation base and other facilities.
* What type of ambulances does the county require, type two or type three.
* Does the county require an integrated dispatching center, what software hardware do they require.
* Radios, what type of radio system the county requires.