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New Castle County advisory board debates ambulance billing, collection shortfalls and centralization options
Summary
At a New Castle County Fire and Ambulance Advisory Board meeting, members and fire company representatives debated whether to include EMS billing in an operational study, raised concerns about low collection rates (some as low as 29–35%), and discussed voluntary county RFPs and vendor penalties. The committee asked procurement to research vendor options.
The New Castle County Fire and Ambulance Advisory Board spent much of its meeting Wednesday weighing how ambulance billing affects volunteer and paid companies and whether billing should be folded into a county operational study or handled separately.
The panel opened the discussion by noting a Sussex County ambulance-billing RFP that counties can opt into “voluntarily,” and several members warned that signing onto another county’s contract could cost local companies money if a low-performing vendor is used. A committee member said, “If our companies lose x amount of thousands or hundreds of thousands of dollars, I would think that would be a concern,” and urged the board to consider potential loss of income when evaluating RFP options.
Danny Spottle, who identified himself during the meeting, reviewed earlier statewide work on ambulance funding and legislation. A participant who served on a 2014 ambulance task force summarized the outcome: three laws and a cost-recovery formula that, the member said, explained how some ambulance bills reached roughly $1,400. “So that rate … is where these $1,400 ambulance bills come from,” the committee member said.
Fire company representatives told the board their net collection rates vary widely by service area. One company representative said lower-income districts with high Medicare and Medicaid enrollment often see collection rates “anywhere between 29–35%,” a shortfall speakers said is unsustainable for many volunteer organizations.
Speakers described insurer practices that hinder recovery, including instances when insurers remit payments to patients rather than to ambulance providers; a committee member said that practice can divert funds away from fire companies and complicate collections. The group also discussed how equipment and regulatory changes (for example, new CPR devices and power-lift stretchers) have added substantial costs.
Members did not adopt a policy shift during the meeting but agreed to gather more information before deciding whether to centralize billing, piggyback on another county’s contract, or pursue other options. The board signaled interest in inviting a billing/insurance expert to brief the committee on legal and practical barriers to improving returns.
The committee’s next steps included asking procurement staff to research potential vendor options for ambulance-billing services and to return with recommendations on timing, procurement vehicles and likely impacts on local companies. The motion directing that research passed by voice vote.
The advisory board will continue the conversation at its next meeting, when members plan to review vendor recommendations and finalize the operational-study scope.
