During the heat wave 10 years ago this summer, Modesto firefighters responded to dozens upon dozens of calls for emergency medical care.
Nearly two weeks of 100-degree-plus heat led to the deaths of roughly two dozen people throughout Stanislaus County. Many other heat sufferers got help and survived. Some had Medicare or MediCal coverage. Some had private insurance. Others had nothing. Those who had coverage paid the same for the fire department’s response as those who didn’t: Zero. Neither did their insurers. It has been that way since the department began handling EMT/paramedic duties in the 1980s. First-responder medical care by fire department EMTs and paramedics remains a free service.
That could change later this year, though. Earlier this week, Modesto Fire Chief Sean Slamon proposed billing insurance companies for the emergency medical calls handled by city fire paramedics and EMTs. By emergency medical calls, we’re talking about responses to strokes, heart attacks, heat prostration, broken bones from falls or anything else that might require stabilization before an ambulance crew arrives to transport.
Modesto residents already pay for fire inspection fees, but not first-responder fees, whether the incident is at a home, business, public place, an auto accident or crime scene. Slamon said the fees could generate about $1 million annually for the department, which he would use in part to add paramedics to his staff. The city would charge only the insurers – not the individuals – and there are 24,556 people in Stanislaus County who became insured under Obamacare through the Covered California exchange during the first two enrollment periods, plus those covered by employer plans.
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Modesto’s Fire Department provides no ambulance service. That is done by a private company, American Medical Response, which can bill Medicare, Medicaid or MediCal as well as private insurers. But none of those government insurers pays first-responder fees, nor can the individuals be billed for them, a representative of Whitman Enterprises told me. That company handles the billing for the Sacramento Metropolitan, Cosumnes and other fire agencies that charge fees.
Already, the fee concept is drawing opposition. Dave Thomas, a longtime government watchdog and member of Mayor Ted Brandvold’s budget review committee, is against it. Some of his concerns mirrored those of readers who commented on reporter Kevin Valine’s story posted on The Modesto Bee’s Facebook page.
“People already pay taxes,” Thomas said. “Billing the insurers will just raise rates. People are going to pay higher premiums. The rates will go up. (Insurers) aren’t nonprofits. They’re in business to make money.”
Though some people are now insured through Covered California, their plans have high deductibles – some as high as $6,000, Thomas said – and if the insurer won’t pay, it won’t matter.
During the Valley’s 2006 heat wave, some heat sufferers said they were on fixed incomes and didn’t think they could afford to pay the increased costs of running their air conditioning units. Thomas said the same would happen if the Fire Department begins charging for the first-responder duties.
That hasn’t been the case thus far in the Cosumnes Community Services District, which covers Elk Grove and Galt, since it instituted a fee of $147 per response a couple of years ago.
“That has not been communicated to me, that we’ve had people who were afraid of (calling 911 due to the fee),” said Tracey Hansen, the district’s fire chief.
That agency also faced initial blowback from residents who opposed the fee. But it overcame the opposition because the agency was able to show the public through a series of meetings the need to overcome the adverse effects of the recession.
“We hired an outside firm to do an assessment of the department,” Hansen said. “Because of the recessionary impacts, we were browning out engine companies, doing without some of the basics. We’d cut spending like crazy and held dormant admin and support positions, and left positions vacant. The public, I don’t think, knew any of that (until it was presented at the meetings).”
The district involved folks from senior agencies, since seniors often require first-responder services. They included school officials. They also promised to keep the fee in place only until the economy restored the tax revenues that put the department back on solid footing again. When that happens, the fee will stop, she said.
“We had unanimous support from a large cross-section of the community,” Hansen said. “Sure, there are people who don’t like it. But we also prorated the fee. If there’s an accident and two engines respond, but there are several people (needing treatment), we’ll assess $147 twice and then divide it by the number of people.”
The fees, Hansen said, will have generated $450,000 during the fiscal year ending June 30.
Modesto hasn’t determined what it would charge.
“We haven’t done the cost of recovery,” Modesto Chief Slamon said. “But it’s not a free service. There is a cost to it.”
Or at least there soon could be for insurers, at least.