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More information on Cosumnes Fire Dept First Responder Fee

This topic contains 23 replies, has 0 voices, and was last updated by  plasmadrive 3 years, 4 months ago.

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  • #177544

    EGL Admin
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    We asked Cosumnes Fire Department Fire Chief Tracey Hansen some questions on the first responder fee.

    Question on the fee. Before treating someone, is the person informed there may be a fee? I can see where there could be some confusion if a person on the scene is offered medical care and doesn’t realize it’s a charge. Also is the fee charged to every person that is helped? For example an accident and there are 5 people and all are looked at, are all 5 assessed a fee?

    Answer:

    Our crews do not make the billing information the focus of their responsibilities at the scene of an emergency. Their sole focus is assessing and treating any patients they encounter at scene and mitigating any hazards found. The fee is allowed by state law (CA Health and Safety Code 13910-13916) and was instituted to recover the costs of providing advanced life support services on our engines and truck in our jurisdiction. Those critical service delivery costs are not covered by property taxes. Similarly, we charge a fee for transporting patients in our ambulances. These fees are intended to provide cost recovery only, not profit. When the fee was being considered, we completed considerable public outreach. In fact, we put together a committee representing those in our community that might be most likely to use our medical services. We went “on the road” presenting to Elk Grove and Galt Chambers. I met with the residents at local assisted living facility. We put on a meeting at the Senior Center in Elk Grove. We shared our consideration for the fee with the local newspapers. During those meetings we shared the all the information about the proposed fee with everyone we met with, and that we were considering adopting the fee to address the costs of providing the advanced life support services. This amount of outreach when considering a fee n not typical for most public agencies, but the CSD has a long history of doing considerable public outreach in may of these types of things. During the time we were considering the fee, our agency was suffering deep cuts in property tax revenues due to the recession. We had a rotating engine company closure nearly everyday which was significantly effecting our response times to emergencies in the affected response area. We saw this as an opportunity to cost recover for those services easing the burden on the General Fund thereby allowing us to reinstate the daily staffing on the engine company that was closed. As you know, we were able to eliminate that engine company closure months ago in part due to the relief felt by this revenue source.

    The fee amount was developed by an independent consultant hired to objectively look at the costs for the service. They took the typical time a first responder engine or truck is at scene of a medical aid from our historical records, which turned out to be 20 minutes. They considered the costs of personnel on the engine, the wear and tear on the apparatus themselves, etc. for that 20 minute window in coming to a number to recover costs. At the time of the fee implementation that was $143, but may be adjusted each fiscal year based on Medical CPI, so it has gone up slightly today at $147 . Our fee application is also unique in that we prorate the fee based on the number of patients and the number of units that respond and are directly assigned patient care at an incident. For example, when we respond to a structure fire there are many engines and trucks at scene. Let’s say at that structure fire we treat a patient. The fee would be charged based solely on the engine and/or truck companies who participate in assessing and treating the patient, not the total number of resources as scene fighting the fire. If the medic unit at scene handles the medical need and no engine or truck company personnel assist, there is no First Responder Fee applied. If the engine or truck company are cancelled before arrival at a scene the fee is not applied. If the person we contact is not a “patient” as described by state law and county protocol, there is no bill applied. The fee is triggered by the patient care record generated we gain the details about whether or not the incident qualifies for application of the fee based on the fields filled out by our paramedics at scene.

    This fee is increasingly common across the state; it is not unique to our agency. I can say that our fee is lower than any other fee of this nature in the state that I am aware of. This is based on the deep dive our consultant did in ensuring that it was based on cost recovery only and developed in as friendly a way as possible, at our direction. The fee is also unique to each agency based on their respective cost of providing these services. The fee must be billed to all qualifying patients equally. We cannot pick and choose who gets the bill. If the fee is determined in an appeal to not be in the “public interest”, under the law the board can waive it. This waiver request must go to the board or the board must delegate that authority to staff members for carrying out. Since the fee was intended to be temporary and the Board wanted to maintain a high level of awareness on the fee program, they wanted these appeals to come to them. When a patient requests a waiver they simply need to send me something in writing. A simple one sentence e-mail can be enough. If the patient wishes to offer me additional details as to the justification for waiving the fee, I bring those to the board as well. The balance of the work on the appeal is handled by staff. When staff prepare the staff report for the board, the patient may review it ahead of time to ensure it captures their “side” of the story and includes all the facts. The patient may come to the board meeting when the item is to be heard if they desire, but it is not necessary. Some have criticized us for not having this good Samaritan example in our Ordinance so we could have waived the fee automatically, but as you might imagine there any number of circumstances that may create a need to consider a waiver. That list would be impossible to predict. As a result, we just included the language for the appeal process and staff would do all the legwork, should a patient wish to appeal for a waiver.

    In Mr. DeAnda’s case, we applaud his stopping and intervening to assist that family in their time of need. We would never discourage that action when it is safe for the good Samaritan to do so. Mr. DeAnda was not billed because he was a good Samaritan, because he accessed 911, or because he was offered a bottle of water.

    Because Mr. DeAnda was injured, he qualified as a “patient”. Our personnel are required by state law and county protocol to assess anyone at scene with an injury (no matter how minor), offer treatment and transport, and document that interaction. That was what was done here with Mr. DeAnda. That patient care report documentation triggered the fee be processed by our billing contractor. The billing contractor should have prorated the fee for Mr. DeAnda in accordance with our fee program as described above, but failed to do so. That was quickly corrected. His fee under this program is actually $29; however, in reality, the issue at hand here is not the amount of the fee at all, it is about billing “Good Samaritans”. I get that, and we are trying to make it right through this board-adopted ordinance we MUST follow. We communicated that information to Mr. DeAnda previously, but never received his request. We have, based on his public comments regarding his intent to appeal, initiated that appeal on his behalf. We will bring that item for the Board’s consideration at the first meeting in July.

    I know this is a VERY lengthy response, but I feel compelled to offer you a detailed answer to put this whole scenario into context. Only part of the information we offered in our interviews with the Sacramento CBS affiliate were offered, which have understandably infuriated people. I also recognize that fees are not popular in the first place, so no matter what the justification, some will not be satisfied.

    Again, we deeply value Mr. DeAnda actions that day. We are doing our part to assist in addressing this fee application and seeking the board’s approval for waiver on his behalf. We sincerely hope to eliminate the fee for all patients in the very near future. We are committed to ensuring this fee is temporary.

    If you need any follow up, please don’t hesitate to contact me.

    Tracey Hansen
    Fire Chief
    Cosumnes Fire Department
    10573 East Stockton Blvd.
    Elk Grove, CA. 95624
    916-405-7100 (Office)
    916-675-6622 (Fax)
    traceyhansen@csdfire.com
    http://www.yourcsd.com

  • #294241

    SteveB6509
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    That’s a fabulous response and I am glad we have had the opportunity to hear the full CSD response to this situation – we are lucky to have them providing services here.

  • #294236

    violarose
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    Oh dear. Don’t get sick. Thats my advice. Just the cost of hubby staying home to take care of me. and then the bills that came with being sick. So I was left with seizures. The cost of fire trucks, ambulance, Er’s. Would beg them not to take me, they would just wait till I would pass out and damm they got me. Thank you fire trucks for being there. Thank you, and may I never ever see you guys again . 🙂

  • #294224

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    @steveb6509 126421 wrote:

    That’s a fabulous response and I am glad we have had the opportunity to hear the full CSD response to this situation – we are lucky to have them providing services here.

    It’s nice that we have agencies that are so responsive. The good thing about this type of media is that there is no time or space constraints and they can answer more fully since it is a complicated issue.

  • #294239

    kindrlindr
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    While that is a very lengthy well thought out response, it still doesn’t make it acceptable that he was billed at all. Are they trying to insure that people are never going to stop and help someone because of the fear that they will receive a bill now?

  • #294242

    loonyman
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    @kindrlindr 126427 wrote:

    While that is a very lengthy well thought out response, it still doesn’t make it acceptable that he was billed at all. Are they trying to insure that people are never going to stop and help someone because of the fear that they will receive a bill now?

    I think the better question to ask if you ever find yourself in such a situation is “Am I going to be seriously injured or killed if I stop to help?”

    Stopping to help in a situation like this seems like the natural thing to do but it is really, really dangerous to put yourself in that situation, especially if you are on the freeway or a fast moving boulevard. People drive by you extremely fast and it is very easy to get injured or killed. So please, if you do stop to help do so in a safe manner. I think the question about receiving a bill from CSD has been answered adequately by the Chief.

  • #294245

    EGdonald
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    One bit of advice I got from others is – if you yourself know your injuries are just scrapes and bruises, then you can say “yes, sure, I want a quick check”. If nothing is wrong, then you’re not (I think?) obligated to give your information to the provider.

    So, if Mr. DeAnda was checked out and they said “you’re fine… can I have your name and address please? Or ID?” – he could possibly say “no, thanks.”

    Or if you ever find yourself in a good Samaritan situation, after you do your deed and proper assistance has arrived, you could take off 🙂

    Also – another point to consider – that $143 fee Mr. DeAnda incurred, that should be covered by his health coverage.

    *disclaimer: I have no legal authority in the above statements :). They’re all guesses on my part.

  • #294243

    loonyman
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    @egdonald 126430 wrote:

    One bit of advice I got from others is – if you yourself know your injuries are just scrapes and bruises, then you can say “yes, sure, I want a quick check”. If nothing is wrong, then you’re not (I think?) obligated to give your information to the provider.

    So, if Mr. DeAnda was checked out and they said “you’re fine… can I have your name and address please? Or ID?” – he could possibly say “no, thanks.”

    Or if you ever find yourself in a good Samaritan situation, after you do your deed and proper assistance has arrived, you could take off 🙂

    Also – another point to consider – that $143 fee Mr. DeAnda incurred, that should be covered by his health coverage.

    *disclaimer: I have no legal authority in the above statements :). They’re all guesses on my part.

    All good information and correct, unless you want your name in the news or on Social Media. I don’t think that was his intention in this case.

  • #294233

    newmom
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    @egdonald 126430 wrote:

    One bit of advice I got from others is – if you yourself know your injuries are just scrapes and bruises, then you can say “yes, sure, I want a quick check”. If nothing is wrong, then you’re not (I think?) obligated to give your information to the provider.

    So, if Mr. DeAnda was checked out and they said “you’re fine… can I have your name and address please? Or ID?” – he could possibly say “no, thanks.”

    Or if you ever find yourself in a good Samaritan situation, after you do your deed and proper assistance has arrived, you could take off 🙂

    Also – another point to consider – that $143 fee Mr. DeAnda incurred, that should be covered by his health coverage.

    *disclaimer: I have no legal authority in the above statements :). They’re all guesses on my part.

    They would have gotten his name and address from the CHP. He would be in the report. I’m also sure he didn’t know he’d get a bill when they asked for his info, or when the paramedics insisted on checking him out, that a bill would follow.

    As for insurance covering the fee-many people have high deductible plans and nothing is covered until you reach that.

  • #294225

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    @kindrlindr 126427 wrote:

    While that is a very lengthy well thought out response, it still doesn’t make it acceptable that he was billed at all. Are they trying to insure that people are never going to stop and help someone because of the fear that they will receive a bill now?

    The bill was only because he had a cut and they offered medical attention. Once medical attention is given they have to follow the policies.

    I mentioned this on Facebook. I am curious what Mr. Deanda did prior to contacting the news media? Did he contact the CSD and ask for it to be waived? Or did he just not pay it?

    I don’t think he did it for media attention either because this happened last year and he never mentioned it.

  • #294226

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    @newmom 126434 wrote:

    They would have gotten his name and address from the CHP. He would be in the report. I’m also sure he didn’t know he’d get a bill when they asked for his info, or when the paramedics insisted on checking him out, that a bill would follow.

    As for insurance covering the fee-many people have high deductible plans and nothing is covered until you reach that.

    some things are covered and not part of the deductible and some are. Our insurance sucks so i just assume we pay for everything.

  • #294232

    joy
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    I agree that it is great to get (more) complete responses on here. It helps with a more balanced perspective. Although I have to say that maybe I misread it, but I hope the fire chief didn’t mean to say that a $1200 ambulance ride to Methodist Hospital doesn’t make a profit. And that was 5+ years ago.

  • #294240

    kindrlindr
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    I just hope its not some lame policy that will hurt people in the end……..I am a giver and I will help PERIOD. I just hate people saying “its policy” when stupid things happen..you know like “policy” is infallible and can’t be changed when its the RIGHT THING TO DO.

  • #294246

    EGdonald
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    @joy 126441 wrote:

    I agree that it is great to get (more) complete responses on here. It helps with a more balanced perspective. Although I have to say that maybe I misread it, but I hope the fire chief didn’t mean to say that a $1200 ambulance ride to Methodist Hospital doesn’t make a profit. And that was 5+ years ago.

    I actually wouldn’t doubt that claim of “not-for-profit”.
    Considering the number of ambulance/emergency medical companies available in addition to CSD, they may not always get every call to recuperate expenses to maintain availability of emergency services.

    Expenses I would guess would be:
    1. salaries for ALL fully trained personnel (ranges from fire response – i think they’re generally trained EMTs(?) – to mechanics and non-emergency staff that are hired to help maintain equipment, etc.
    2. the health care and other benefits paid to each staff member, employee
    3. medicine stock (and the replacement of after either use or expiration, etc) in emergency vehicles
    4. equipment costs (maintenance, repairs, vehicle fuel, etc)
    5. grounds/building costs
    6. more?

    $1200 for 1 trip sounds hefty for a single person to pay. But just like budgets and taxes 🙂 it depends how much is available and used.
    If in the ultimate extreme case, if CSD had to support staff to serve all of Elk Grove, and during 2015 they only called out to 1 single ambulance ride – I’ll assume they’d have spent millions of taxes/funds to take that 1 patient into emergency/hospital care.

    But if on a yearly basis, 100’s of thousands within Elk Grove actually used emergency services, I’m sure the costs would adjust appropriately.

    *again 🙂 I have no evidence or hard facts of my assumptions above. Just speculation on my behalf at this point :

  • #294227

    EGL Admin
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    @joy 126441 wrote:

    I agree that it is great to get (more) complete responses on here. It helps with a more balanced perspective. Although I have to say that maybe I misread it, but I hope the fire chief didn’t mean to say that a $1200 ambulance ride to Methodist Hospital doesn’t make a profit. And that was 5+ years ago.

    True. Hard to say without knowing the numbers. My thought is that the cost of labor is the same whether they are on a call or waiting for a call at the station. I guess in theory the less calls they get the more expensive it is for the CSD. A $1200 ambulance bill is extra money. I’m sure they figure that into the budget though. Kind of a tricky situation.

  • #294234

    newmom
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    @EGL Admin 126436 wrote:

    some things are covered and not part of the deductible and some are. Our insurance sucks so i just assume we pay for everything.

    The only thing covered under our policy until we reach our deductible each year is a yearly physical-but no labs or extras with it. No meds, no eye check, no hearing check, no cholesterol, etc.

  • #294235

    newmom
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    @EGL Admin 126447 wrote:

    True. Hard to say without knowing the numbers. My thought is that the cost of labor is the same whether they are on a call or waiting for a call at the station. I guess in theory the less calls they get the more expensive it is for the CSD. A $1200 ambulance bill is extra money. I’m sure they figure that into the budget though. Kind of a tricky situation.

    I would think the labor costs are the same. Clearly supplies being used and such is going to be different.

    I, for one, don’t agree with the idea of the fees-if you live in their service area. You are already paying for the services on your taxes and special fees and assessments. It’s like being charged double. I have never used an ambulance or needed the services of the Fire Dept in all my almost 20 years living here. Does that give me a credit for future use?

    The cost variances of ambulance rides is interesting to me. Three years ago my dad a a ton of ambulance rides between a hospitals and nursing facilities, all but one pre-approved by his insurance company, and the bill for each (we still saw copies of them) was around $1,000 (this was in Orange County).

    Seven years ago my 15 month old son was taken by ambulance from a hospital in Phoenix to a specialty children’s hospital just a few miles away also in Phoenix. I was told I had no choice as to taking him in my car vs. the ambulance, as he had already been admitted to the first hospital. The bill for that ride was $3,000.

  • #294228

    EGL Admin
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    @newmom 126451 wrote:

    I would think the labor costs are the same. Clearly supplies being used and such is going to be different.

    I, for one, don’t agree with the idea of the fees-if you live in their service area. You are already paying for the services on your taxes and special fees and assessments. It’s like being charged double. I have never used an ambulance or needed the services of the Fire Dept in all my almost 20 years living here. Does that give me a credit for future use?

    The cost variances of ambulance rides is interesting to me. Three years ago my dad a a ton of ambulance rides between a hospitals and nursing facilities, all but one pre-approved by his insurance company, and the bill for each (we still saw copies of them) was around $1,000 (this was in Orange County).

    Seven years ago my 15 month old son was taken by ambulance from a hospital in Phoenix to a specialty children’s hospital just a few miles away also in Phoenix. I was told I had no choice as to taking him in my car vs. the ambulance, as he had already been admitted to the first hospital. The bill for that ride was $3,000.

    I’ve got a ridiculous story you’ll appreciate. A few years ago my mother in law was at the Kaiser south hospital for an appointment. She left and then fell down in the parking lot near her car. She broke her ankle. They had to call the fire department to come get her and take her to the hospital. The hospital would not come out and get her. The bill was I think $1000. She had Kaiser so most was covered but her share was still something like $250. I understand that is hospital policy I guess, but that is just one of the non common sense things that people deal with. They had to take an ambulance and fire truck off duty to come do this.

  • #294237

    Scarlet
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    Wait – they called the FD to bring her in? They would not hand you a wheel chair and you take her in yourself??

    When my daughter was born almost 22 years ago we called 911 – she was born before they arrived (and Joy knows how close they are to our home) – Everything was done, except for the ride to the hospital. We received a bill for around 600 to 680, can’t really remember. I sent to our insurance company and they denied it because it wasn’t pre-approved. I had to explain that wasn’t planned, had to talk to quite a few people to get it approved. I can’t remember how much ended up being covered.

  • #294244

    loonyman
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    @scarlet 126458 wrote:

    Wait – they called the FD to bring her in? They would not hand you a wheel chair and you take her in yourself??

    When my daughter was born almost 22 years ago we called 911 – she was born before they arrived (and Joy knows how close they are to our home) – Everything was done, except for the ride to the hospital. We received a bill for around 600 to 680, can’t really remember. I sent to our insurance company and they denied it because it wasn’t pre-approved. I had to explain that wasn’t planned, had to talk to quite a few people to get it approved. I can’t remember how much ended up being covered.

    It is a liability issue. They can’t just give you a wheelchair. Thank our litigious society.

  • #294229

    EGL Admin
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    @scarlet 126458 wrote:

    Wait – they called the FD to bring her in? They would not hand you a wheel chair and you take her in yourself??

    When my daughter was born almost 22 years ago we called 911 – she was born before they arrived (and Joy knows how close they are to our home) – Everything was done, except for the ride to the hospital. We received a bill for around 600 to 680, can’t really remember. I sent to our insurance company and they denied it because it wasn’t pre-approved. I had to explain that wasn’t planned, had to talk to quite a few people to get it approved. I can’t remember how much ended up being covered.

    She was by herself. Someone saw her fall and then called me from her cell phone. If one of us was there, we would have probably got her in the car and drove her to the emergency.

  • #294230

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    @loonyman 126459 wrote:

    It is a liability issue. They can’t just give you a wheelchair. Thank our litigious society.

    Yep. People sue for everything. A few years ago our niece wanted to have her 14th birthday party at our house because we have a big backyard and a pool. I said no because we didn’t know her friends or their families and I was thinking okay what if someone gets hurt? There’s zero benefit to us and all the liability

  • #294247

    plasmadrive
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    @EGL Admin 126464 wrote:

    Yep. People sue for everything. A few years ago our niece wanted to have her 14th birthday party at our house because we have a big backyard and a pool. I said no because we didn’t know her friends or their families and I was thinking okay what if someone gets hurt? There’s zero benefit to us and all the liability

    And again I say.. this is what lawyers have done to us as a society..

  • #294248

    plasmadrive
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    @EGL Admin 126456 wrote:

    I’ve got a ridiculous story you’ll appreciate. A few years ago my mother in law was at the Kaiser south hospital for an appointment. She left and then fell down in the parking lot near her car. She broke her ankle. They had to call the fire department to come get her and take her to the hospital. The hospital would not come out and get her. The bill was I think $1000. She had Kaiser so most was covered but her share was still something like $250. I understand that is hospital policy I guess, but that is just one of the non common sense things that people deal with. They had to take an ambulance and fire truck off duty to come do this.

    Blame lawyers..

  • #294231

    EGL Admin
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    @plasmadrive 126478 wrote:

    Blame lawyers..

    You can sue for anything and not need any proof. The courts accept the suit as fact for filing purposes. Then those being sued have to prove it’s not legit to keep it from going to trial.

  • #294238

    govwatcher
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    I think the Chief fully explained it. If he had not been injured, or had refused to allow the medics to look at this cut – then there would not have been a fee. The financing of first responders has been getting progressively more complex and convoluted for many years now. Lots of us think that all the services should be covered by our property taxes. Those taxes cover safety response for police and for fires – ONLY. Many moons ago fire depts did not provide medical services. Now that is the vast majority of what they do. Look at a breakdown of calls sometime. All the fire departments report of the breakdown at least once a year. I am with Steve B – we are blessed with the first responders that we have here in Elk Grove.

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