SLO ambulance charges second highest in state

August 10, 2009


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

Monterey $1,298

San Francisco $893

Santa Barbara $1,391

Santa Cruz $1,036

Ventura $1,251

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.

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By: rferris on 10/16/09

valid points but not the controlling ones. The 911 system could certainly handle dispatching from many more service providers, if there were more it would be more likely to be there quicker as there would be more to choose from.

Agreed no one shops for rates in an emergency,but that does not mean if there was competition that folks would not know the pricing in advance and depending on the circumstance might actually specify a lower priced provider and accept a slightly longer wait. Depending on the circumstances…not all ambulance rides are immanent emergencies.

It is also the case that with competition even the high priced operators would lower their prices or find themselves out of business. The high rates we suffer are a direct result of a government set up monopoly and benefit only the players within the existing system and not the puiblic as a whole.

All the self serving justifications of SLO’s outrageous rates fall on deaf ears unless the rest of the state is somehow magic and only SLO has the costs you so adroitly describe.

There has never been the beneficiary of a monopoly who did not make the same or very similar statements that we are seeing here.

By: NobodySpecial on 9/3/09

There is a reason it’s called an opinion section. You don’t have to agree with me. My sources are my experiences and this is only my opinion. I am not representing any agencies. I am however a career Paramedic in this county and I’m familiar with how things work here, so my opinion is more than a guess. I support open dialogue. I consider myself a patient advocate I would do my job for free if I didn’t have to feed a family.

That being said, I’m not against competition- I’m just trying to shed some light on why i believe the system is the way it is.

When a contractor gets a contract to build a house, another company can’t show up one morning and start working on that house claiming “competition”. But they can compete against each other during the bidding process just as any other ambulance company can with SL Ambulance whenever their contract renews.

As for real-time competition: If we’re talking about a true emergency, then there is no time for people to be calling and shopping around getting quotes to see how much the ride will cost. Fast, appropriate care is most important. The 911 system does not fit into a normal business model thats why the county steps in with mandates and contract requirements.

If companies were competing for “the ride” then would they try to lowball their competition? What will they base their estimate on?

“How sick is your grandma? Flu? We’ll transport for only $800. Cleaning up vomit is $50 extra. CPR $1000 + medications. If we have to carry her down stairs its $20/step. We need to have your insurance or credit card # for pre-approval before we dispatch an ambulance though.” I could do this all day… Will there be ambulance commercials and newspaper ads like the hospitals are doing now?

Adding another company wouldn’t add EMT jobs either. More people won’t call 911 just because there’s another game in town. Current EMT’s and Medics would be laid-off from SLA as work declined and would transfer from one company to another. The only change would be the uniform and the paint job…

I’ll bring back the 5 Cities Ambulance example: If you lived in SLO and you called 911, you got SL Ambulance. No choice. If you lived in AG you got 5 Cities- like it or not.

2 companies with different equipment, different (though similar) bills. Competition? Not really… You could have a different company in every city in the county but it still wouldn’t give the 911 caller an option of who shows up. Whoever ‘owns’ the response area gets the call. The system now has the entire county under a unified dispatch with SL Ambulance and CCHD working collectively to cover each other’s areas without delay in care. The most important thing here is providing fast, appropriate care to the patient remember?

SL Ambulance and CCHD have the best equipment available to save a life and some of the best trained staff of almost any ambulance agencies around. If you never use them, its free. If you do, it’s priceless.

By: rferris on 9/3/09

nobody special should not be afraid to reveal his links to this subject. From his posts I would say his ox is being gored…. STILL no real answer to why competition would be bad for anyone but the beneficiaries of the current monopoly situation.. (Yes a Franchise is a monopoly )Setting up straw men to knock down is commonly used to defend an egregious practices. The examples used always go to extremes and do not actually speak to the issue. If a movie reference is your example of why competition is bad I think you are grasping at straws.

By: NobodySpecial on 8/31/09

Why limit it to ambulance charges though? Why isn’t all healthcare charging what it actually costs? It has nothing to do with price gouging…

A band-aid at an ER shouldn’t cost $500 and a night at a hospital shouldn’t cost $15,000. They charge what’s required to actually collect what they intended from the start. Example: If you know you get ten cents for every dollar you bill and it costs $100 for your product to break even… You’re probably going to charge $1,000 for your product.

I’d blame Medicare…I’m guessing if everyone paid their bills, we could be billed actual costs- but we don’t live in a perfect society.

rferris- the county does not sponsor this business nor is it a monopoly. Let’s not forget Cambria Community Healthcare District… San Luis Ambulance has to meet multiple, restrictive requirements set by the county in order to do business here. Our county is not lacking for EMT’s or equipment either. SL Ambulance more than meets the required minimum staffing in their contract. They are one of the only ambulance companies in the country with a waiting list to get hired (at a time when other companies have to offer hiring bonuses to attract Medics). There is no need to staff additional ambulances, as there would be no call volume to support it. Adding supply will not add demand. If another company were coming in to try to share the current calls, they’d possibly be driving UP the prices so they too could break even. Up until about 7 or 8 years ago there was another ambulance company around here. Remember 5 Cities? But like every other system, the caller didn’t get to choose who responded to their 911 call. It is all broken down into response areas. This is typical across the nation. For a good example of why it can’t just be a free-for-all “911 sale” might I suggest a viewing of an old Bill Cosby movie- Mother, Juggs and Speed.

By: rferris on 8/28/09

EMT 1 can certainly speak from self interest, but how does having more EMT’s more equipment and fair competitive prices be bad for the citizens of S>L>O> county? My posts do not constitute sitting at home and complaining. I will guarantee that all EMT’s have a lot more time to kill than I do. Being on call 60 hours a week is not the same as working a small business more than 60 hours a week so I think EMT 1 should not leap to his conclusions

Reasonable comments by effected parties is what a free society is about. EMT 1 and his defense of high ambulance charges only attempts to stifle comments by disparaging those whom he disagrees with.

By: karebear on 8/28/09

I have seen a person call 911 for an ambulance, walk out her front door to get on top of the gurney, go to the hospital and be back on her chair smoking a cigarette in 2 hours flat! And we, the taxpayers paid for it! If she had to pay for it, surely she would have asked a family member for a ride to the hospital.

By: emt1 on 8/27/09

Its people like the rferris and cindy who have nothing better to do than to sit at home a complain about everything. Until you walk in my boots and do the job I do 60 hours a week, I sugest you keep your limited lack of knowledge to yourself. And a respondisble person would know when to call 911 and when not.

By: rferris on 8/27/09

When private business have a government sponsored monopoly the rhetoric to excuse the price gouging never ends. What about competition.

You EMT’s out there must realize with competition additional EMT’s will be needed, additional equipment would be available to serve our large county. With more EMT’s and more equipment it’s hard to figure how this would not result in superior service. How many deaths are caused by responsible people who are aware of the high cost and not feeling they can afford the ride?

By: NobodySpecial on 8/27/09

To be clear, the county is not charging the ambulance company money. If you are speaking of the first responder fees, these are charged by each fire department and the amount depends per city with SLO being the highest and majority. These fees exist as a ‘thank you’ bill courtesy payable to the FD when an ambulance is occasionally delayed beyond the normal response time. Since responding is their job and they are already paid by taxes to do it, billing a private company extra for the FD to show up seems a bit like extortion to me…

$1,800 is an expensive ride, yes. As mentioned before, let’s take into consideration the expenses of operating this business when a unit is not transporting: Rent, upkeep, and utilities on 8 stations a shop and Headquarters, buy and maintain 22 ambulances, Supervisor units, mechanics, office staff, 120 field personnel (with medical benefits) on duty 24 hours/day including holidays, training, supplies, FUEL, insurance, etc… Now subtract the more than half of people who don’t pay their bill. Subtract out first responder fees. I’m actually surprised this company manages to turn a profit. BTW- The owners actually took a pay cut and cancelled the company X-mas party to save money. Is this a sign of a company that is manipulating the public for its own wealth?

By: emt1 on 8/26/09

$1800.00 is a very small price to pay when your LIFE is on the line.

By: Cindy on 8/26/09

rferris – I agree wholeheartedly. It’s become clear that while out tax dollars are already paying the FD to respond (which can be very helpful in an emergency) the county has found it’s way to making an extra dime by charging the ambulance service for every call. This gets charged back to the citizen’s under the guise of a charge from the ambulance company.

“It’s a RIPOFF” and “It’s BULLSHIT”.

No one has yet to answer my question, is this standard policy in other CA counties? This will be a good follow up for CCN later.

By: rferris on 8/25/09

We are from the government and we are here to help….ourselves to as much of your money as we can make off with. When a city enters into an exclusive franchise agreement, competition goes out the window. It soon becomes a mutual benefit society at taxpayers expense. All it takes to have a reasonable price on ambulance service is to get rid of the franchise agreement and allow competition! THIS is what you always end up with when you have a government sponsored monopoly. The original need and reason for the service are forgotten once it becomes a cash cow for both the county and the operator of the ambulance service. 1800.00 for a ride to the hospital is wrong and all the self serving excuses and rationalizations do not change the fact that 1800.00 is a ripoff!!!!~!!

By: NobodySpecial on 8/22/09

A few things have yet to be mentioned here that I believe are important.

-Mr. Kelton doesn’t just decide how much he wants to bill the patients that get a ride. The county REGULATES how much he is allowed to bill and how much profit the company is allowed to make.

-There is competition. The county awards a contract to a winning bidder which SL Ambulance happens to have won for several consecutive terms.

-Medicare only pays something like ten cents for every dollar that is submitted to bill.

-True, fire medics and ambulance medics are both initially trained to the same license, but fire medics have to maintain knowledge in multiple other areas such as Hazardous Materials, Fire Safety, Incident Command, Rescue Systems, Etc… All an ambulance medic has to focus on is good patient care. They also tend to run more calls per day per medic meaning more practice.

-A reason to have the fire medics there is because your tax dollars have already paid for them and there are more of them meaning quick response (good for Cindy). But, recent studies are showing additional medics on a scene can frequently have a negative effect on a patient outcome and add an average of 5 minutes on scene.

-If you never call an ambulance, you’ll never spend a dime on an ambulance. If you never call the FD, too bad.

-Some of the most recent reasons people have used to request ambulance transport that might explain the rising cost:

“I can’t afford the taxi”

“I’ve got Medi-cal so it’s free (to me)”

“I don’t want to wait for the bus”

“I’m too drunk to go to the shelter” (appreciated honesty)

“I don’t want to wake up my roommate”

-Paperboy-there was a non emergency transport company around a few years ago that had contracted with the hospital. Sounds like the MB couple might have tried the wrong route. (Essentially you’d have to be a taxi with a bed)

By: PacoLopez on 8/20/09

Yes, the prices are high. But if you don’t want to get a 2,000 bill don’t call an ambulance if it’s not an emergency. And I hear that a lot. If you need to go to the emergency room and you can get up or be helped my a family or friend and go the ER that a way to avoid that bill.

By: Rany on 8/19/09

Looks like nothing is going to get resolved around here. There are no real answers, just a lot of “shucking and jiving”. I hope there will be some follow up.

By: Cindy on 8/18/09

Here we go again. What does the fact that he only had a broken arm have to do with the fact that he was charged $2,800. Nothing, it has nothing to do with the cost. You just pull excuses out of a hat. You charged 3 times the average cost in this state, why?

” Frank Kelton, the owner of San Luis Ambulance, points to the county’s low volume”

On one hand you say you need more business and on the other hand you complain when a paying customer uses the service because it wasn’t an emergency. You are putting on nothing but a BIG DOG & PONY SHOW HERE.

Why do you charge so much more than every other county?

By: emt1 on 8/18/09

Well if your confused by paying $2800.00 for a ride to the hospital, let me ask you this, was it life threating? Could you have gone to the ER by private car? 911 was built around the thought that you would call 911 in LIFE OR DEATH situations, no one ever died from a broken arm. So its calls like this that insurance will not pay due to the fact that it was not a life threating injury. And this is to problem, until people start using the system the way it meant to, you will be paying $2800.00 for a ride that could have cost you maybe $5.00 in gas in your own car.

By: Cindy on 8/18/09

Does anyone besides me feel like we are all getting the run around. We pay the 2nd highest rates in the state but everything is just fine. I haven’t heard one reason why it cost’s $2,800. for a ride with a broken arm! Welfare, we certainly don’t have the 2nd highest welfare population in the state. It’s a mess and no one has a solution or viable explanation. Just folks.

By: emt1 on 8/17/09

All of you have great ideas on how the “911 system” should or should not work, but take it from someone who works in the system, the system just fine the way it operates. The cindy’s of the county who have one good expeirance with a F.D., thinks that ambulance service is lacking is just unfair. Anyone who works in the EMS field would check on a past patient to see if they did a good job and the outcome of a call, but to take that step and go see that patient? Its like they need the recongtions for what they did. That is our job!!! We save peoples lives and to get reconized is nice, but to seek it out is scary. Do you have your grocery clerk seek you out to see if they did a good job bagging your groceries? And as far as F.D. transporting, come on do the math, it would cost more than the $700,000.00 first responder fees that the local F.D. already get for doing nothing more than just showing up. And with the concern of having a centralized dispatch system, it would work if your local cities where willing to give up their dispatches. They are the ones who fight it. How the dispatch works depends on where you live, if you live in any local city with a police of F.D. your call goes through them, then they dispatch the F.D. then the city dispatcher calls the sheriffs dept, how dispatches the ambulance. And you wonder why our response times are long? By the time we get a call, its been active 4 or 5 minutes before we are even notified. So do not put the blame that we are always late, most of the time we beat the Local F.D. and we are the first responders, and we still have to pay that “first responders fee”. Until you walk in ours shoes, quit pretending that you know what your talking about.

By: Cindy on 8/17/09

SURFER510 say’s: “So I don’t think you got what I was saying at all”.

Actually, I did get what you were saying. It’s possible that I have some inaccurate information from this blog, either that or we have all been playing Russian roulette.

Question: True or false? The FD-EMS is required to respond to every call. The reason is that they are considered first responders and failure to do so (respond, not necessarily get there first) could result in litigation.

By: SURFER510 on 8/16/09

cindy one more thing I checked the ambulance RFP for this county and the private ambulance comapany provides all the Fire department equipment and re stock items. if you have the fire department assume it then they have to pay for everything all over again. Basically the only reason that the fire dept has first responders is because of the money the private ambulance company pays them now.

By: SURFER510 on 8/16/09

An article on how FDNY will be raising the prices of ambulance transports. This is also after in New York city the tax rate just to pay for staffing is 7.5% of total city take and they still have to pay out of pocket for ambulance transports.

By: SURFER510 on 8/16/09

CINDY- So I don’t think you got what I was saying at all. You are correct they are first responders right now BUT they are working on a fire engine the LEAST amount of people on an ENGINE is 4. Now subtract 2 for the operation of the ambulance, that leaves 2. Now if you want the dept to not hire anyone new then everyone that is qualified to work the ambulance will have to do forced overtime. And as BEEN THERE pointed out its not cheap or cost effective. I understand Cindy that you think that since pay for a service with your taxes you feel that you should get more for what you pay. I agree whole heartedly I also have to pay taxes. But it all boils down to this: Either pay extreme taxes for something that you hopefully never need to use, or pay nothing except if you ever need a ride to the hospital. I would rather as a civillian pay for a service when I use it rather than pay for everyone who abuses it and hopefully maybe need it once or twice in my life. By the way BEEN THERE I’m with you I agree.

By: BeenThereDoneThat on 8/16/09

Wait a minute I’ve got it. The accountant is probably the union. They figured that the pension plan retirement (probably give them 110% of pay) the extras and the good ol nothing but the best on the taxpayer dime.

Yep that is probably why the inflated numbers.

I will have to say thanks to Surf for one thing. I am ALWAYS a bigger supporter of private business over Govt. With the ambulance as expensive as it is now, you definitely made the case of why it is better in private hands than the Govt.

By: Cindy on 8/16/09

SURFER510 – Wait a minute. First the FD is already acting as first respondents so the crew is already staffed. What they don’t do is the transport. So what we are talking about is an extra 30 minutes per call.

Second- there is an article in the Tribune today. Templeton is making plans to bring on their own FD. An outside firm was brought in to do the cost analysis. They estimate that to bring in two full time staff members and to maintain a self sustaining FD will raise property taxes by approximately $116 annually per residence. Business’ will be assessed by sq ft, but they don’t have a whole lot of business establishments.

I think all we have to do is consider how many properties are subject to taxes in the county and divide by 700K (quick slam/dunk method). Then add the cost of the ambulances and we will have a ball park idea close to the increased property tax assessment per payee. I guess business’ wouldn’t be subject to the added assessment.

P.S. The FD EMS already have heart monitors and all that jazz. They have all the equipment that the ambulance staff has.

By: BeenThereDoneThat on 8/16/09


I agree with cindy. $2500?? You are kiddin right. Look. Right now I pay $3800 in properity taxes. Recent house bought in 2000. I would guess most average cost is at least $3000. Now that doesn’t just pay local that pays everything from local to state county etc.

Are you going to tell me that we need almost the same amount to just run a service like you mentioned, just in this county alone?

I question your book keeping practices. I would like to see real numbers, because I find these highly questionable.

I don’t disagree that taxes won’t go up (already stated as such) but I would bet it would be more in the neighborhood of $100 a parcel in the county. That is quite a bit in a years time.

Think about it. What my taxes are paying now in my city alone cover at least 20 paid police officers, 20 plus fire, and lets not even get started on city staff, then state etc.

And you are trying to tell us that four extra people per city will cost almost the same? I would love to meet the accountant that you said did the numbers.

By: SURFER510 on 8/16/09

CINDY- Ok it works like this; you normally have 4-5 firefighters per engine. You need 2 people to work in an ambulance. You cant have an engine with 2-3 people on it because thats not enough to even get water through a hose so if you wanted your fire dept to get an ambulance they would hire new emt’s and paramedics to work on the new ambulances. Here is a scenario to think about if you did it the way your thinking of: you call 911 because one of your family memners is having a heart attack, the ambulance responds with 2 people from the engine. While they are at your house they get a fire call and now there is only 2-3 guys at that station they wouldn’t be able to go ar they would have to call another engine to come with them. Now think of that scenario but with 20 medical calls going on and even one fire comes in then well i guess your house and every other thing in that neighborhood is going to burn to the ground. So the 2,500 per household goes into new employees new ambulances and equipment. A new heart monitor = 15,000, all the other little stuff that you don’t even thing about costing a lot is roughly 150,000. Everyone knows that hospital visits cost a lot and the stuff they use is expensive right? Well all that stuff in the ambulance comes from medical suppily companies and they don’t take any less from a fire dept for the same stuff.

By: Cindy on 8/16/09

SURF510 – What (?) it would cost each family an additional $2,500 annually? That makes no sense. The fire fighters are already EMT’s and paramedic’s. When they aren’t fighting fires or doing EMS what else are they doing? We so happen to have a massive fire right now but really, how often are they out fighting fires vs sitting around waiting for one? We have to pay the fire fighters salaries regardless of whether they do EMS or not so where is the added expense? Adding an ambulance to the FD fleet cost how much?

I don’t buy it. Now what is it that I don’t understand? Thanks for your input. We are all trying to figure this puzzle out.

By: Cindy on 8/16/09

BTDT – I wasn’t following you initially because I always believed that EMS was a part of the FD services and included in our taxes. I think most citizens believe that, especially since the FD doesn’t bill a citizen directly but rather “swings it” through the ambulance company. Also if the EMS comes out and the citizen isn’t transported, there is no charge from anyone. This also leads one to believe that the FD EMS is included in our taxes. I don’t think many citizens believe otherwise.

By: SURFER510 on 8/15/09


I also would like to point out that what I was trying to get accross was that even if you taxes paid for the physical ambulance your taxes would not be able to cover the equipment and the salary of medics and emts for the entire year on top of paying for the firefighters as well. My dept which I will leave out for ovbious resons looked into what it would cost taxpayers and it breaks down to about an additional 2,500 a year in property taxes or other taxes. Now think about how much you pay for your insurance premiums. Add that up and take into account that is on top of the taxes that you already pay for police and fire. And you would still have to keep your insurance policy so you can be treated once you are in the hospital. Either way its a system that ovbiously broken in some aspects but the only place I know of in the world that does it for free is Canada and their taxation is upwards of 50% a year so even they are paying a premium for it.

By: BeenThereDoneThat on 8/15/09

To Cindy.

Here is part of an early post of mine.

“Last anybody oppossed to the high cost of ambulance rides, are you willing to have this taken over by S.L.O. County with a tax increase on all, to pay for this? That way it is like police and fire and you pay for it weather you use it or not.”

Yea thanks for the tip but I got it all along and was trying to point that out.

If our taxes had payed for (ambulance) we wouldn’t pay. Obvioulsy we don’t pay for the fire department to come put our house fires. Or the police to breakdown our front doors. Oh wait. Yea in the case of Atas. recently we will pay the gentleman for all the damages caused. ;-)

By: Cindy on 8/15/09

Thank’s for the clarification SURFER510.

I went back and re-read this article. Sure enough it’s right there.

“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)”

I wonder how many of us missed that the first time?

So if you break your arm in SLO county and are in too much pain to get yourself to the hospital you can anticipate a $2,800 ambulance ride. Your insurance company probably won’t cover approximately 30% of the fee, as it will be considered excessive by all standards.

I guess the next logical question to ask is whether it’s a common practice for county’s to charge first responder fees? This certainly explains why our county controls the contract and run’s competition out of town. $700,000 a year worth of explanation!

Why not just have each FD maintain its own transport vehicle? I think the answer is because EMS isn’t included in our taxes like we all thought it was folks.

By: SURFER510 on 8/15/09

So let me make something clear as someone who has worked on both sides of this argument. I have both worked on a private ambulance and a fire ambulance now and let me tell you that either way you have to pay for an ambulance transport. The fire dept doesn’t advertise that fact but all our tax money mostly goes into new engines and our salary and let me tell you that I make considerably more for a fire dept than I did when I was with a private ambulance company. Also as it was mentioned on here by someone else it is true that the private ambulance companies do pay a subsity to the fire departments so that they can have paramedics on the engines and so that they will respond to medical calls. As with anything in this country nothing is done without the motivation of profit and that is even true with fire departments. So you may feel better to have a red ambulance respond rather than a private one but really you are getting the same care and the people that run that entity are responding for your money not out of the goodness of their hearts.

By: ruth on 8/14/09

The Fire Department needs to take over transport. Many fire departments have thier own in-house ambulance that the fire medics work. This would get rid of the private ambulance company and actually provide a better service for the city of SLO. The fire department usually always gets to an emergency first because thier are more fire stations than ambulance’s in the city at one time. Believe me, you don’t want to wait for the ambulance to show up…they could be coming all the way from Morro Bay.

By: BeenThereDoneThat on 8/13/09


Yea how about the 3 different cases this year of morons calling 911 asking for police because they were at fast food and didn’t get their order.

In each case it was less than 10 bucks!!

Like you said we definitely need to educate people on the use of 911 all around.

By: easymoney on 8/13/09


I am just a firefighter who goes when called, whether it is a critical incident or a frivolous 911 call. We do what is needed regardless of judgment, and gladly accept the responsibility. All firefighters are bound to the same ethics as other medical technicians and good samaritans.

We do not judge, so it is up to the caller to make the determination as to whether it is really serious or frivolous incident. My point of posting is most citizens do not exercise good judgment when dialing 911, they just expect immediate response regardless of severitiy or realistic conditions.

It has become engrained, in the public that regardless of repercussions or cost, they will trigger EMS, be it a bee sting or blister.

By: Cindy on 8/13/09

Ok easymoney, since your a volunteer fire fighter and paramedic I’m going to tell a bit more of the story about the day the FD saved my mother. These guys were really something special, very special.

Not only did they work on her 25 minutes before they handed her over for transport but her condition was so serious that when the ambulance arrived that crew stood back and just let the FD do their thing. Her heart kept stopping and the FD kept bringing it back (3 times), but it doesn’t stop there.

Five days later while I was at the hospital these 3 guys came walking into ICU. My dad jumped up and started crying all over them (he was a WW2 vet by the way, not easily taken to crying)he couldn’t say thank you enough. Need I say who these 3 guys were? It turned out that they had been checking on her status because they wanted to follow up on how effective they had been. When they heard she was off life support and sitting up talking they said they had to come and see for themselves. They were so happy, the doctors and nurses praised the FD paramedics and said her survival had them all surprised because she had been that seriously ill.

By: easymoney on 8/13/09

Any one who has actually seen a fire engine would know right away, there is no where to actually place a patient for transport. Fire engines are very expensive and built primarily for response to fires or vehicles accidents. They do carry medical supplies, and are capable of ALS or BLS, depending on the type and department.

And once again, if you are unhappy with your current EMS provider, contact the SLO County Board of Suppervisors as they sign off on all contract aggreements. much like trash or cable service, only so many companies meet the spec and the price the County uses.

And cindy, I am glad your mother received the great first responce by your local fire department that probably saved her life. That is the primary job of the fire service, first response.

And for those who still want to whine, call the board of sups and let them know that you do not like the service they have agreed to. And for those who complain the loudest, try stopping by aqny San Luis Ambulance location or your local fire station and actually see who they are and what they really do for you.

By: BeenThereDoneThat on 8/13/09


Thanks for that info. Then I ask why the ambulance? If the fire department did the job and our taxes pay for that, why the ambulance? Again trying to get to the heart of why the redundancy?

By: Cindy on 8/13/09

BTDT. The fire dept generally has the fastest response time. You can’t wait when there’s a heart attack, severe loss of blood and the like. If it wasn’t for the FD my mother would have died in 1991 rather than 2009. A call to the FD generated a response time of an amazing 2 min 37 seconds. I know the response time because she wasn’t breathing when my dad called. We were all concerned about brain damage and were relieved when the FD records revealed the time without oxygen. The paramedics from FD also got her heart going. The ambulance arrived 15 minutes later!

By: BeenThereDoneThat on 8/13/09

If the fire department does have paramedics, then why the redundancy? That is a HUGH waste of money to pay the fire department if they are going to bow to the ambulance once on scene to take the call.

This does get me thinking about something you see a lot. Has anyone noticed that when there is something like a heart attack at the local store or the neighbor next door, they always have both a fire truck and and ambulance. O.k. I understand the ambulance but why the fire truck? Is the person at risk of spontanious combustion? That seems like a waste of fire personel. Even if it is fire paramedics how many paramedics do we need on scene?

By: Cindy on 8/13/09

EMTB- I’m a little , actually a lot confused here.

“SL ambulance pays each fire dept. a huge (first responder fee) amount of money just to get the call first.”

SLA doesn’t have any competition that I know of , maybe your saying that they pay the FD to get there in a hurry and help because SLA is often slow to arrive and that we are already paying the FD to respond? I don’t understand why or what SLA is paying the FD for? Does anyone else fully understand what EMTB is conveying to us?

By: EMTB on 8/12/09

For all of the uninformed opinions that are listed above, you really need to do some homework. The cost of an ambulance ride is justified for those who need it. I think a previous writer wrote, that in the time of a true emergency, SL ambulances was the cheapest bill out of them all. The majority of calls received, are non emergent. People have the right to refuse service of the ambulance and get in there own cars and drive to the hospital, but they don’t, for what ever reason. The ambulance personell don’t have that option. They have to take someone if they want a “taxi” ride to the hospital.

If you want to save some tax money, Take ALS fire depts. and make them BLS. Most city fire depts are paramedics. They are paid very well for arriving on scene first, and not (for the most part) needed , or for that matter, they don’t even do the paramedic job. SL ambulance pays each fire dept. a huge (first responder fee) amount of money just to get the call first. SL ambulance arrives on scene many times before the fire dept. Don’t we pay them already to be there first???

If SL ambulance didn’t have to pay the first responder fee (set forth by the greedy fire depts.) the rates would be cheaper. The article above is correct in the amount charged. It is justified. The above writers need to look at the big government that is lying and being lied to by all the people getting the money. Its a scam. Unfortunatly the “private” ambulance company is the first to be looked at for reform, silly people!

By: JorgeEstrada on 8/12/09

I have no problem with tax dollars being spent on public safety as in the fire departments. They are proactive in monitoring public safety and certainly are already funded to respond.

The more I think about it, the ambulance is antiquated. They should be licensed as medical couriers so that every delivery counts. I can hear the sirens now!

My opinion is to curb the not so free extra-enterprize, limit redundancy and take that life saving ride in the vehicle we all pay for. I say, that will remove a high cost and improve service. Obama is working on the hospital cost….ya

By: BeenThereDoneThat on 8/12/09

Thanks for the info Cindy.

By: Cindy on 8/12/09

BTDT- Difference between EMT and paramedic. That was a good question and there is a big difference. I just looked it up. You are correct in that an EMT can not break the skin. They (paramedics) also have approx 1000 hours additional training.

By: BeenThereDoneThat on 8/12/09

I wish we could get a blogger on here that is working as a Paramedic past or present.

I have a friend of mine that worked (before on permanant disablity) for CDF and as an EMT who rode with a Paramedic.

I asked him once years ago what the difference was between a Paramedic and EMT. He said that it is basically drugs. In that the Paramedic can start drips etc. and start administing drugs etc. on the way to hospital. I don’t know if this is true or not? Anybody?

Could they (ambulance service) split one and one? One Paramedic one EMT. This might save some on costs?

Does anybody know. I think Cindy has an idea in that can we start small and work up as the accident/incident scene dictates?

By: Cindy on 8/12/09

BTDT has good points. Why not put the contract out for bid and see who responds?

I still think that we should just include it in the duties of the fire departments. They are all trained EMT’s and first responders. Whats the big deal about including transport to a hospital. We are already paying the fire fighters salaries anyway. All we have to do is add (or revamp) a few transport vehicles. Problem solved.

BTW- While they do respond to calls they don’t have to play taxi for a broken toe. There is no law that says they have to provide emergency transport for a non emergency.

By: BeenThereDoneThat on 8/11/09

My guess is that the startup costs will not motivate a company to want to come to this area to compete for such a small base.

It is the same reason why only one cable company. I remember back in the early 90’s in Atascadero, everybody was wanting competition. For that business it would have cost 10 million they said for the infrastructure.

I know I know different. Point is, is that it would require equipment (ambulances, med. equip. supplies etc.) building rent or buy, insurances from workers comp to vehicle to building etc. Staff. My guess is probably a couple mil.

So can you find someone who wants to put up that outlay (and find financing in a bad economy) to get started and the risk waiting for the return on money invested?

By: HonestyPlanet on 8/11/09

Maybe, just maybe, the answer involves competition. Is it possible that two, or possibly three companies might provide the service. When the county is contracting out a monopoly, the result is often somewhat less than competitive pricing. So, why not contract with several companies, and always call the cheapest one first?…..Or, at least give the caller an option?

By: Saveslocounty on 8/11/09

If you want a real story, check into CalStar air ambulance service and report their fee schedule. The CHP helicopter program is outstanding and is FREE to the patient as our tax dollar has already paid for it. CalStar even filed a federal lawsuit to bypass local fee schedules. Fortunately for us taxpayers, their case was thrown out of court.

I agree that medical care is costly and that if everyone that received amblance services were to pay, the cost would be outragous. But, that is not the case as they have many freeloaders that jack the bill up for all of us. My appreciation of San Luis Ambulance and their staff remains unaffected by this report.

By: BeenThereDoneThat on 8/11/09

Another point on this. Something we may not see (costs) on fire personnel is cost of standby. We don’t see a bill for this or anything else from them for that matter, because our taxes are paying for it.

The ambulance company again is private but has to be on call. The money they are charging is not just for that call. It is also for the down time so that they are ready and available when needed. When they are not at the scene they still are drawing paychecks, overhead (lights, properity, gas etc.) is still running up the bills.

Then take all these costs of doing business and half don’t pay? Of course costs are going to seem unreel.

What do people think would happen to Wal-Mart prices if half the customers stopped paying tomorrow? Do you think that they are going to provide you a product and service at a loss?

Oh and PLEASE no whining about Wal-Mart having nothing to do with this. DUH. I am using to make a point.

Last anybody oppossed to the high cost of ambulance rides, are you willing to have this taken over by S.L.O. County with a tax increase on all, to pay for this? That way it is like police and fire and you pay for it weather you use it or not.

By: easymoney on 8/11/09

to cindy, URkidding right?

As a firefighter, we do not “just sit around waiting for fires”, the bulk of all calls we go on are Medical Aid and Vehicle TCs. Firefighters are trained andn recertified continuously as EMTs, ambulance crews are trained up to paramedic level.

When the pager goes off, dispatch has taken the 911 call, determines the best resources for the type of call and location, sends the resources to the call and does constant updates through radio contact.

That being said, yes there are MANY frivolous 911 calls, but it is not up to us to make that determination, we go when and where we are dispatched. And many calls have several areas of concern for both patients as well as first the first responders.

San Luis Ambulance does an extremely good job and the County contracts with them, through the Board of Supervisors. The EMS is a complicated and expensive system, with many agencies involved, so when you call 911 because of a “medical emergency” be prepared to see at least three engines and an ambulance respond, UNTIL the IC is on scene and determines whether the responce is warranted.

Otherwise drive yourself to your own doctor to get that splinter removed…

By: rukidding on 8/11/09

Cindy-Because of ambulance chasing attorneys the ambulance has to respond to all calls as they should. The abuse comes people who are programmed into “the system” who abuse the use of the ambulances at times because they consider it an entitlement along with all of the other perks that government provides to them fro our tax money.

By: rukidding on 8/11/09

To Cindy-I would suggest that you acquire a scanner and listen to the amount of what I consider to be frivolous calls that the ambulance company responds to. These calls consist of headaches, sore toes, diahrea, upset stomach and many calls to California Valley for the above mentioned ailments. Someone has to pay for these calls. Good service comes at a price. Unlike most other areas the response times are at times extraordinary due to the area of coverage. When these long response times occur the ambulance company has a very impressive back up program where different ambulance are moved around within the county in order that we still have the appropriate service that we always receive.

By: Cindy on 8/11/09

BTDT – You have an interesting point about how having one ambulance company avoids confusion but Paper Boy is right on with his approach. Competition is the key to the problem.

With today’s technology it would be easy enough for all dispatchers to have the ability to consult an online site (in seconds) that would make them aware of who was on stand by and available. They could make decisions as to not only who is available but who is the closet. We need some competition in this county. Sounds like there might be too much hand shaking going on.

By: mccdave on 8/11/09

And by the way, for you Obamaniacs who think the death panels aren’t real? They are! See this:—obama-death-panel-debate#s-p1-st-i1

So just pay the f**k up and be glad the ambulance isn’t taking you to a granny euthanasia camp.

By: Cindy on 8/11/09

rukidding – No one is complaining about the service it’s a question of why the cost of the service is 2nd highest in the state? Certainly we don’t have more welfare recipients here than every other county in the state?

I think Jorge Estrada has an excellent solution. The fire dept are trained paramedics and when they aren’t fighting fires they sit around and do nothing (which is most of the time) for an excellent pay, benefits and retirement plan. They often arrive before an ambulance anyway and are just as capable as the trained ambulance personnel. They should start doing transport.

BTW Paperboy, I’m the lady that talked about having a hurt shoulder and being taken advantage of because I had excellent medical insurance. I assure you that I didn’t “DID NOT” take a ambulance to the hospital over my shoulder. You were thinking of the welfare recipient with the hang over.

By: BeenThereDoneThat on 8/11/09

Just asking. Is it possible that cities contract with only one ambulance company to avoid confusion?

In this I mean that fire and police while sometimes in multiple locations they are controlled by one entity (city) and they can dispatch appropriately.

With ambulance companies being run privately, in a case when time is of the essence, could there not be lost time in deciding which to dispatch because not sure if they are at their home base or out at another location? Imagine if there was 3 seperate entities?

I do not like monopolies but on this one I would like to hear of a better way to do, while still insuring safety?

By: paperboy on 8/11/09

So you like free markets and low costs? Then eliminate the SL Ambulance’s countywide monopoly and open it up to competitive bidding.

Years ago, a paramedic from Fresno and his wife (also a paramedic) tried to start a ”non-emergency” ambulance transport business in Morro Bay to transport people to the doctor or hospital who were not an immediate emergency (like the lady here with the hurt shoulder) and were proposing to charge about half what SL Ambulance does.

And the city flat turned them down. The city manager wouldn’t even bring the matter to the city council after the ambulance company pitched a fit.

Again, it’s high-paid, well-benefitted government employees making decisions that affect the little people, and protect the status quo.

If you want to retain a free market and lower costs, the only way to achieve both is through a competitive business climate. Every city has an agreement with the ambulance company, giving them a monopoly to operate within the city limits. With the county on board too, there is no chance for competition, so when the company says it wants a rate hike, there really isn’t much that can be done about it.

And frankly, the company’s coverage is weak. We have one ambulance to cover MB and Cayucos and all the points in between. If that rig is on a call then they make the one from Los Osos available, unless that one too is on a call, then they have to send a rig out from SLO, and on and on and on.

So we’re basically paying top dollar for minimal coverage.

By: rukidding on 8/11/09

San Luis Ambulance saved my life. I went to Twin Cities Hospital while having a heart attack and received exceptional care. I had to be transported to Sierra Vista for a treatment that was unavailable at Twin Cities. While in the back of the ambulance preparing for transportation I went into full cardias arrest and was revived by the ambulance crew and an attending nurse. There bill was the least expensive of any that I received during my treatment and recovery at both hospitals.

Thank you San Luis Ambulance for your great service to the community.

By: BeenThereDoneThat on 8/11/09

Another point on last. Insurance is mentioned. Don’t they call it MAL PRACTICE INSURANCE???

By: BeenThereDoneThat on 8/11/09

I’m confused by this post.

“It’s news, it’s interesting, and it is part of the huge equation we are all faced with now about the general cost of health care, insurance and related issues.”

Then it is contradicted by the statement that mal practice has nothing to do with?

You can’t be serious? Mal practice is part of the equation. Do you really think that it doesn’t contribute to the costs of health care in this country? Amazing.

By: hotdog on 8/11/09

We certainly have a bunch of characters reading this site. The article is about rising costs and give credible reasons (whether or not you agree or like them). It’s news, it’s interesting, and it is part of the huge equation we are all faced with now about the general cost of health care, insurance and related issues.

The bloggers are whining all over the place with their drivel, starting with shooting the messenger! Then another wanders off into mal practice issues with fantastic claims.

The subject of the article is rising costs of the Ambulance service here. No one likes that, but we might find some sense or answers with the feedback of caring and intelligent readers. A number of reader/bloggers seem intent on childish rants rather than contributing info that adds to the discussion.

By: BeenThereDoneThat on 8/11/09

I love Cindy’s post.

A point I would make to that, is look how bad it is now that people take advantage of the system. Does anybody think the system will be better and less abused when we start subsidizing everything? I know that some people will only care when it is to late and their tax bill is out of sight!!

Also I am a little confused about the history lesson. I thought from all my studies that checks and balances had to do with the branches of Government?

I do agree on the free trade. We are screwed. Don’t know what that has to do with the ambulance but I do agree.

By: Cindy on 8/11/09

Only 50% of transports pay and the rest of us pick up the difference in cost. The fact is if you want great health care just get yourself on welfare. It’s easy if you have a couple of children. You can throw responsibility out the door and dine on lobster tail and get drunk and use drugs for days at a time. No need to worry about the hangovers, just go to the emergency room for a “banana boat” (it fixes your hangover). Think I’m kidding? This woman had section 8 housing and had a lovely apartment in Atascadero. She attended paid schooling (compliments of us tax payers). She was studying to become a drug and alcohol counselor! We didn’t pay for her schooling once but on 3 separate occasions. She never did pass or stay sober and drug free. She went to Albertson’s and would purchase lobster with her food stamps! I kid you not. Her X husband didn’t have to pay any support because they had a 50/50 childcare arrangement, 1 week with her and 1 week with him. Her kids had braces for their mild crooked teeth (compliments of us tax payers) and when she felt too sick from her drinking she would call an ambulance and say she needed to be detoxed when all she really had was a nasty hangover. She was on probation and wasn’t supposed to be drinking but the hospital doesn’t report it so she called the ambulance all the time when she didn’t feel well. She say’s she can’t work because she injured her back which happened when she was DUI and rolled her car (we all paid those medical bills too) but she sure can water ski and do whatever else she wants. the expense doesn’t stop there either, we pay for her and her children’s psychological counseling,the cost of probation officers checking on her, public defenders,drug & alcohol programs and its gone on for years. Her friend once told me that he would be getting section 8 housing because he was a recovering alcoholic! What the f***? I’m told she still gets special housing, food stamps and spending money, hell its been at least 9 years that I know of. Her children don’t even live with her anymore but who seems to care. The FREE RIDES have to stop if any of us are going to afford to pay when we need a ride.

Sorry folks, I just needed to get that one off my chest.

By: JorgeEstrada on 8/11/09

Since we already have the fire department at the scene, why not have them finish the job and shuttle the patient to the hospital. Certainly they can become, if not already, as qualified. The volunteer fire departments, already under mutual aid agreements with other agencies, through consolidation would better serve as full time staff.

I do know that most fire department calls are medical emergencies and they should have suitable vehicles for prompt pick-up and delivery.

Other than the time I was hauled off by an ambulance, from the curb side of a fire station, I know very little about the ambulance business. It is common knowledge that lawyers chase them.

By: Use_it_or_Lose_it on 8/11/09

-Check your early American history and how our forefathers wanted checks and balances. We used to have tariffs like the rest of the world does, but now we have “free trade” and we’re screwed.

I like capitalism too, as CEO of United Behavioral Health I love my $4,000,000 a WEEK salary and my $766,000,000 in stock options.

I NEEEEEED this way more than you need to see the doctor.

By: BeenThereDoneThat on 8/11/09

Oh and one last on the people I covertly work for. If people don’t like your idea then you also are the SPINMASTER. Wasn’t that the thing that Susan Summers promoted in the early 90’s? ;-)

By: BeenThereDoneThat on 8/11/09

I always love these blogs. I now have worked for the insurance industry, hospitals, on the campaign for Parkison, I have worked for all the investment groups mentioned on the blogs, etc. etc. etc.

I love that when when people can no longer debate an idea that the whole world is in on some dark sinister campaign against them, because it is so hard to believe that there is other points of view other than theirs.

The story mentions that it is 50% payback.

So here is an idea. How about people that hate capitilism so much come work for me for free the first four hours of every eight hour day. Oh I know that people will whine that’s not fair. Well that is what you are asking this company do do.

If we don’t have the deadbeats pay and we set the ambulance companies scale and their operating costs are still more than profit one of two things have to happen. Either it gets subsidized by you and me the tax payer or they go out of business. That is reality.

Now please lets debate and share opposing views and remember we aren’t all hiding behind the curtain in the land of OZ. This here is reality.

Well I have to get back to work. I am very busy because of all the above mentioned things I am involved in. ;-)

By: mccdave on 8/11/09

Black_Helicopter: “If you’re over 65 and your condition appears to be expensive, you will have to walk.”

No, if you’re over 65, they send out a white garbage truck to transport you to the Soylent Green factory. But be warned: Dubya turns 65 in two years, so I’d switch to Soylent Blue for awhile in 2011.

Great to see volunteers for the insurance and hospital interests spreading the cuckoo-for-cocoapuffs stories here. BHC’s “sources” aren’t anonymous. They’re Astroturf efforts by Rick Scott, the crooked former head of Columbia/HCA, and Dick Armey:

But I at least hope the government doesn’t take over Medicare. ;)

By: Black_Copter_Pilot on 8/11/09

I have information from reliable but anonymous sources (maybe we have the same sources, Karen) that when Obamacare happens, that the ambulance services will be nationalized.

When that happens, the only thing that will matter is your age and what ails you. If you’re over 65 and your condition appears to be expensive, you will have to walk.

All card carrying ACLU members, on the other hand, will be given transportation without further qualification.

By: BeenThereDoneThat on 8/11/09

Another thing. It is mentioned that they are reimbursed for 50 out of every 100 transports. That is only 50% and people are besmirching the ambulance company? How about everybody getting on the DEADBEATS a**es that cost all the rest of us. That is also another place were those costs trickle down to the rest of us.

By: BeenThereDoneThat on 8/11/09

You are kidding about not the lawyers right?

Are you serious? I am not saying only problem but give me a break!! I for my forty plus years have watched all the B.S. lawsuits in medical that have lead to high malpractice insurance. When the medical

industry has to pay higher insurance costs and costly lawsuits who pays? Not them it is the end user.

I remember an example of excess as an off shot to the lawyer and law suit industry. Back in the 80’s there was a lady who was injured or killed (not quite sure which) in a Chevy Monte Carlo. It caught fire somehow (don’t remember specifics) and they sued G.M. The jury awarded plantiff 4 BILLION dollars. Who do you think would have paid for that? G.M.? This country is littered with hundreds of cases (not as big as this but big) like this every year.

How about lawyers taking a 33% cut in most cases as a minium. Oh I’m sure they will say….it is the cost of doing business. Hmm sounds familular.

Also medical advances in this country have FAR outpaced the rest of the free world in the last 20 years.

How about people that go to the emergency room for the common cold? What do you think that does to costs?

I am not in the medical industry but have read and followed information on this for years. Yes there are some things that are over priced but that is not the only part of the puzzle here. I just think that one article is over simplifying a very large and more complexed problem as a whole.

How about the costs of MRI’s. VERY EXPENSIVE. That is because the machines cost over a million dollars. It takes time to make money to run it, pay staff, make profit and pay it off. Oh and don’t forget again insurance to cover.

Big Pharma. There is a lot of R&D that goes into it and if it stopped there it could maybe still be cheap but again if one of these meds kills someone you know for a fact that lawyers will be the first in line to sue and it does happen.

Also on Big Pharma then I would assume anybody that doesn’t like them I would hope is opposed to the new Healthcare bill. Read in this past Sun. Trib that Big Pharma is on board for the healthcare bill and putting up millions to help it through. Why would they, when they have been opposed in the past to federal regulated medical plans?

By: sww on 8/11/09

San Luis Ambulance response time? When I called they came, several people argued with me about what is and is not a seizure and they FINALLY took my loved one to the hospital. I left 10 minutes later, obeyed speed limits, and arrived at the hospital at the same time as the ambulance. It’s only 12 miles from my house on major roads. I tried to tell the ambulance driver that there was a better route than what he chose but he argued with me too. I was quite calm both times. Dickheads. You can’t fix stupid.

By: Use_it_or_Lose_it on 8/11/09

– Start with lawyers?

Start with greed, then Big Pharma, then greed.

SLO Ambulance second highest in the state.

SLO Cops highest paid in the state. For what?

By: BeenThereDoneThat on 8/10/09

You want cheaper health care? Cheaper insurance? Cheaper ambulance? Start with lawyers.

By: Cindy on 8/10/09

mcdave, I had a similar experience (being seized upon) when I went to an emergency room with an injured shoulder. I had excellent insurance and they tried to admit me before they even had the ex-rays back and they were already scheduling me for an MRI. I was in tremendous pain and had been for over 24 hours before I decided to look into it. I was told they couldn’t give me anything for the pain unless I allowed them to admit me and then I could have all the pain killers I wanted! I was incensed and refused to be admitted for an injured shoulder, I just wanted ex-rays (first) and treatment and something for the pain. They finally brought in an orthopedic doctor who understood my dismay. He read my x-rays, treated me for a chipped bone, wrapped me up and gave me some vicodin and I went home with no problems that time didn’t heal. I’m still in shock at that kind of behavior just to (obviously) slam my insurance.

By: mccdave on 8/10/09

BeenThere: “If given the choise to live or die on the way to the hospital I think most would pay.”

Fortunately that’s a false choice, as the comparison to other counties shows. This is a perfect example of where “market” pricing for healthcare services breaks down: ambulance passengers are in no position to shop around or even ask what the cost will be. Pricing for all kinds of healthcare is opaque. It’s clear that regulation of prices makes sense, and other countries manage to do this without sending the elderly en masse to euthanasia centers.

I tried to get an itemized bill from Tenet _after_ a brief hospital visit and had amazing difficulty actually getting one. The whole experience made me see medicine as a racket, which is very bad for the profession.

There are plenty of healthcare providers (and others) that have a monopoly franchise in SLO county and take advantage of it. The rotten attitude alone of some medical groups is testament to this problem.

I wonder if there’s anything peculiar about our combination of cost-of-living, reimbursement rates, numbers of indigent patients, and small market that justifies ambulance costs being so high. If there was, you’d assume that other charges would also be near the top too.

“Medi-Cal pays only $110 and Medicare pays $582 per trip, leaving those with private insurance and no insurance to make up the difference.”

I’ve never had the pleasure of an ambulance ride, but during my overnight hospital stay I definitely felt seized upon as a revenue source because I have insurance. I was offered all kinds of pointless treatments for an extremely simple problem, and declined some. I probably shouldn’t have even consented to being admitted.

By: BeenThereDoneThat on 8/10/09

This is a tough one. It is easy to complain till you need it. My wife had to be transported from Twin Cities to Sierra Vista in the late 90’s while in labor, due to complications.

She had good insurance then (as now) and the bill was just under $1000.00 and they paid……..NOTHING! We had to pay it all.

So for people on Medi-Cal and other Gov. subsidies that my and others taxes pay for and then I have to pay for our insurance and then have to fit the whole bill anyway….suck it up.

If given the choise to live or die on the way to the hospital I think most would pay. They provide a service of life or death. Choose.

By: Saveslocounty on 8/10/09

Gee Karen, what happened to your usual in depth investigative report. Having the misfortune of needing the help of San Luis Ambulance service in the past, I am glad they were there.

What your report does not reflect are the government subsidies paid to the ambulance providers and the overhead costs of real estate for ambulance station in our county.

San Luis ambulance replaced its entire fleet of ambulances over the past few years providing a more suitable size to enhance the care of trama victims. They don’t give those things away. Another point is the 3,000 square miles that SL Ambulance covers which has many sparsely populated areas increasing staffing costs without sufficient offsetting revenue from calls.

Fuel, personnel and insurance costs have have all risen drastically since 2003. Besides, EVERY fee charged by the SL Ambulance has been approved by the Board of Supervisors during a public hearing.

This isn’t much of a story and I am glad to have the professional level of service provided by the SL Ambulance and the Cambria Hospital District Ambulance. They are true life savers that are much better than the higher costing mega ambulance services in metro areas. And, this is a user based fee schedule that is not supported by my tax dollar. I think we should be thankful for the quality of first responder medical service in SLO County.