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Monterey council weighs first-responder fee to help close $10M deficit; insurers, equity and deterrence worries surface
Summary
Staff presented two models for a first-responder fee to recover paramedic treatment costs. Council members and residents split over whether insurers should be billed or patients — staff say insurers rarely pay, which makes patient billing (and related compassionate waivers) the more common but administratively heavy option. Council asked staff to explore legislative paths and refined options before deciding.
Monterey — Faced with a projected $10 million structural budget deficit, Monterey city staff on Dec. 16 presented a proposal for a first-responder fee intended to recover some costs of the fire department’s paramedic services — a program that staff say would not replace ambulance transport billing, but would recover the cost of paramedic treatment provided at emergency scenes.
Assistant Fire Chief Pat Moore told council the fee is typically calculated from a ‘‘fully burdened’’ cost model that includes crew cost (three-person engine company), average on-scene time, EMS supplies and an administrative fee. Staff modeled two approaches: option one (bill insurers only) and option two (bill insurers and, if insurers do not pay, bill patients). Moore cited experience in other California jurisdictions and information from third-party billers (Whitman & Enterprises), reporting option-one net returns are low because most insurers will not pay a separate paramedic treatment fee; Kaiser and some HMOs are exceptions.
"Insurance companies typically…
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