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North Richland Hills staff proposes bundled ambulance rates near market levels; council asks for data on insurance impacts
Summary
City staff recommended moving from itemized low rates to bundled ALS/BLS fees to reflect costs and improve insurance reimbursements; proposed resident discounts and nonresident pricing were discussed but no vote taken.
City staff presented analysis and a proposed restructure of ambulance service charges at the Jan. 27 work session, saying current itemized fees are far below regional bundled rates and produce lower reimbursement from insurers and Medicare/Medicaid.
Jay (presenter, Finance/EMS liaison) summarized that the city’s current billing is highly itemized — supplies, mileage and a 20% markup — and shows markedly lower published rates than neighboring jurisdictions. Staff reported ALS‑1 was listed at $719 for residents ($935 for nonresidents) while nearby cities show bundled ALS charges commonly between $1,600 and $1,800.
The staff recommendation: switch to a bundled fee structure and set nonresident rates near the 70th percentile of the regional market. Proposed example figures given by staff included ALS‑1 at $1,750 for nonresidents and a resident discount of at least 15% (bringing ALS‑1 for residents to about $1,500). Staff also proposed converting other itemized elements (mileage, oxygen) to market‑aligned amounts and continuing use of a third‑party billing provider.
Council asked practical questions about impacts to Medicare/Medicaid, cross‑jurisdiction responses and collection practices. Staff said Medicare and Medicaid rates are fixed and would not change, so most of the change affects private‑insurance and self‑pay balances. The city’s third‑party billing consultant explained bundled fee structures typically recover a higher percentage from insurers than highly itemized bills. Staff said the city does not typically send balance bills for resident patients to collections, a service residents currently receive.
Councilmembers asked for cost data and historical review. Staff said the last rate review was a “couple of years” ago and that rising medical supply and personnel costs contributed to the need for higher fees. Council asked for the city’s trip‑level cost data and additional modeling showing expected net revenue under the proposed bundle, and for clarification about whether changes would harm residents. Staff said they would prepare a revised ordinance and bring it back on a future agenda for approval; no ordinance was adopted on Jan. 27.
Ending: Staff will return with a draft ordinance and additional financial analysis — including per‑trip cost breakdowns and projected reimbursement levels — before council votes on a rate change.
