Who is responsible for paying for an ambulance?

[Blackheartednurse]

So let me tell you about a very complex case I had and also I'm a new RN and still learning the ropes of nursing.Ok so I was admitting a new patient (home health) and when I checked his blood pressure it was extremely critically high 190/110.I double checked also used a second blood pressure cuff and checked another arm just to make sure I wasnt reading it wrong.Well turns out it was high.Well the patient denied headache,chest pain,he basically stated hene was just fine even though his eyes were very very red and he was slightly lethargic.Then he took his evening dose of two blood pressure meds he was on.I rechecked the blood pressure was rather increasing than decreasing and then his respirations were increasing.I called his daughter and she came. She wanted to take him to an emergency room but he refused.We called an ambulance and the the dispatcher who answered our call refused to send an ambulance because the patient didnt agree for one to be send.We tried again and this time a male dispatcher answer and send an ambulance rightaway even thought he was aware that patient was oriented,the dispatcher never asked us if the patient wanted the ambulance to come,he just send one after hearing about his high BP.Now my patient is on medicare and I wonder who is responsible for paying for the ambulance even though the patient refused and the ambulance didnt take him to the hospital?

[GilaRRT]

Nobody, the guy refused and there was no transport. Sometimes people refuse, if they refuse after being educated about the risks, we often must honour their wishes. Assuming an alert patient who can make their own decisions.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Varies by state, maybe even by city or service. In NM the patient is responsible for the ambulance bill no matter who calls for him and even if he refuses transport. A no transport bill will be considerably less than if they take the ride.

[CoffeeRTC, BSN, RN]

I don't know the correct answer either, but since you will be doing home health, you might want to call the local traspo company or EMS and ask them about this for future reference. In some areas residents subscribe to or donate to a local EMS and that covers most of the cost of the service or what ever the insurance doesn't cover.

[Up2nogood RN, RN]

If the patient is alert and oriented all you can do is educate. You can't make him go to the hospital against his will.

How long did you wait to re-check his BP after he took his meds?

Could there have been possibly other reasons his BP and resps were increasing? Pain or anxiety?

I wouldn't say that his BP was critically high but I don't know what his baseline normally is. Maybe next time you can call his physician and ask his/her advice?

[Altra, BSN, RN]

You should definitely have protocols for this -- what findings require a call to the patient's physician, or activation of EMS.

[Medic2RN, BSN, RN, EMT-P]

When I worked as a paramedic/ EMS, the patient was ultimately responsible for the bill regardless of transport. If we took him to the hospital, it would have cost more. I would check your protocols regarding those situations.

[caliotter3]

When I got hauled off by an ambulance service, the very first bill I received for the episode came from them. Before the hospital, before the doctors, before the ancillary services, before any of the other bills. The bill clearly stated that it was me they expected payment from. Since I was in no shape to be calling anyone at the time of service, the medics were called by another person at the scene. They "incurred" the cost for me.

[BluegrassRN]

Wow, in my town there is no bill if there is no transport. Seriously. When I teach safe sitter classes, we always tell the kids "When in doubt, call. You won't get in trouble ever, and if there really wasn't a need for the call, there isn't any charge." I just assumed that it was like that everywhere. Who knew?

[EricJRN, MSN, RN]

When I was involved in EMS, our agency and the surrounding agencies charged a "no transport fee" to a patient who got an ambulance but ultimately refused transport. We got into some really sticky situations involving concerned, well-intentioned third parties who made 911 calls for patients that absolutely didn't want emergency services.

I am surprised that there was a delay in sending help. Even if a dispatcher knows that the patient is not requesting help, at least in my neck of the woods, one is sent and the situation is worked out in person between the medics and the patient - and of course, the fee is assessed.

If your agency doesn't provide guidelines for emergency situations, there may still be some things you can do to help the patient get the care they need. If he's asymptomatic, an SBP of 190 isn't going to be lethal in the next few minutes. Do they give you contact numbers for the patients' physicians? His PCP might have been able to talk him into going to the ER or might have suggested some other course of action to consider.

Just a few things to think about. You live and learn. But yes, there are areas where EMS agencies bill patients for ambulances that they never wanted. I have no idea whether Medicare or private insurance ever covers a refusal fee, but I suspect that they typically do not.

[missjennmb]

I dont know about the charge, but at my clinic, we always call 911 if we feel the patient needs it, regardless of if they want it. We dont even mention that on the phone, because for liability reasons we need to cover our tails. If we call, they come, pt doesnt want it, they and EMS make that decision and we can say we did all we could for them. We call an ambulance for the homeless quite often, sometimes twice in one day, and sometimes patients are just too drunk/high/afraid to go even if they should.

Clinically speaking, some bp meds seem to make bp go higher the first hour and then drop after that. We are a clinic so the situation is different of course, but we treat bp's that high at times. It amazes me how high pt bp can be and them walk around like its no big deal.