Finance committee advances ordinance updating ambulance fees as city takes over EMS billing

The Wilmington Finance Committee on an evening meeting agreed to send Ordinance 25‑012—an amendment to Chapter 10 of the city code revising ambulance and related service fees—to the full City Council for final consideration on May 1.

The measure, presented by Stephanie Mergler, deputy chief of staff for the mayor’s office, accompanies the city’s planned takeover of emergency medical services (EMS) billing from Trinity Health. Mergler said the city will contract with a third‑party medical billing firm, Specklen, to handle insurance billing and compliance. "We have engaged a third party billing company called Specklen, to perform the medical insurance billing," she told the committee.

Committee members were told the ordinance updates fees that have not been changed since 1994 and are intended to align billable rates with industry standards and insurer expectations. Mergler and budget staff said the city expects to bill Medicare, Medicaid and private insurers at the new rates and projected roughly $2.5 million in EMS billing revenue in the first year, with a possible rise to $3–4 million in later years as operations ramp up.

Why it matters: the city is taking over ambulance transport from Trinity Health, which previously billed for EMS and recently changed how it provided service. Updating fees and establishing a billing process are central to offsetting the city’s new operating costs for EMS.

Key details from staff presentation

- The third‑party biller will submit insurer claims; staff said Specklen will not perform debt collection on outstanding patient bills. Mergler said Specklen will send an initial bill and a 30‑day follow‑up for uninsured or self‑pay patients but "does not do collections."

- Example fee changes cited in the presentation: the basic ambulance charge was described as increasing from $135 (the old code rate) to a listed base of $1,000; oxygen administration was shown rising from $20 to $30; and a per‑loaded‑mile transport charge was quoted at $25 per mile. A city staff member said the $1,000 is a base rate from which insurer adjustments and write‑downs are applied before a patient bill is finalized.

- City budget staff and the fire department projected startup and outsourcing costs of about $290,000 for billing and compliance support. Separately, the broader EMS effort added roughly $3.8 million in operating costs to the fire department budget in FY 2026, primarily for personnel and ambulance operations (discussed in the department’s budget hearing).

Council questions and public comment

Council members asked how much of billed revenue the city should expect to write off for uninsured or nonpaying patients and whether the base $1,000 rate is the amount an uninsured patient would actually pay. Mergler said the base figure is adjusted in practice and promised to obtain specifics from Specklen on the expected patient‑pay amounts. A committee attendee identified as "Mr. Higgler" (role not specified in the record) said hospital and billing data reviewed by staff suggested self‑pay patients historically accounted for less than 1% of revenue in comparable operations.

A member of the public, Ms. Bass Knight, commented that the projected payer mix—heavy reliance on Medicare, Medicaid and commercial insurance—should limit billing issues.

Vote and next steps

Committee members moved and seconded a motion to advance Ordinance 25‑012 out of committee for full council consideration at the May 1 meeting. The committee called for a voice vote; members present responded in the affirmative and the motion was marked carried. The ordinance will be considered by the full City Council on May 1.

What remains unresolved

Staff said they will follow up with the committee on: a) the expected share of billed dollars that will be uncollectible or reduced to patient responsibility; b) exact patient‑level charge calculations from Specklen (how the $1,000 base translates to a final uninsured bill); and c) any additional procedural details for billing and patient notices.

Ending note: The ordinance and accompanying fee schedule will determine how the newly municipal EMS program bills payers and patients; the committee advanced the measure to the full council while staff returns with clarified billing impact details.