By Ted Schnell • BocaJump | Oct. 26, 2011

It has been nearly 10 years since Elgin last revised its fees for those who use the city’s ambulance services, and Elgin Fire Chief John Fahy believes the city is losing money as a result.

In a memo to City Manager Sean  Stegall, Fahy said that in addition to not revising its rates since December 2001, the city is not charging for mileage — the distance from where the patient is picked up to the hospital. That is an acceptable charge for Medicare, Medicaid and insurance patients. Combined, the city is losing potential revenue at a time when it is looking to slash away at a projected structural deficit of as much as $13 million.

The City Council tonight, Oct. 26, will consider raising those fees and adding a $10-per-mile transportation charge as well.

The increase is significant, but Fahy said the city has been “grossly undercharging for our services,” particularly for nonresidents and those with medical coverage. Fahy said that as a result, residents are subsidizing emergency services costs to those groups.

Under the proposal, rates would change for the following:

• Basic life support service would increase to $442.75 from $355 for residents, and to $692.75 from $444 for nonresidents.
• Advanced life support 1 service would increase to $525.75 from $422 for residents, and to $900 from $528 for nonresidents.
• Advanced life support 2 service would increase to $760 from $611 for residents, and to $1,135 from $764 for nonresidents.
• A new fee would be added for those who refuse advance life support service. There has been no charge for that in the past. Under the proposal, residents would pay $300  after refusing the service a third time in a 12-month period; nonresidents would pay $400 after each refusal.
• Finally, residents and nonresidents alike would pay the $10 per mile

According to Fahy’s letter, the proposed rate increase for residents still will be less than the average rate charged by 138 Chicago-area communities. But the new nonresident rates would be significantly higher than the average.

Effect on patients

In 2010, the Elgin Fire Department transported 6,159 people to local hospitals — 5,244 were Elgin residents, 915 were nonresidents.

Of that total, Fahy wrote, 3,140 were Medicare or Medicaid patients. Those programs pay the city a set fee that in 2010 was nearly 30 percent less than the fee for 2,890 residents and nearly 48 percent less for the 250 nonresidents in those programs. Medicare and Medicaid patients are not billed for the unpaid difference. Fahy wrote in the memo that the city would see a significant return by raising rates on this group, because both Medicare and Medicaid pay mileage reimbursements, which the city has not charged for in the past.

The bottom line, Fahy wrote, is that Medicare and Medicaid patients would not be affected by the increased rates or mileage charge.

The city is collecting more from insured patients, but it still fell short of the city’s billing in 2010, Fahy’s memo shows. Of the 1,548 patients with group health insurance, 1,148 were residents and 400 were nonresidents. Fahy projected this group would generate a significant portion of revenue, primarily through their insurers. But his memo stated there likely would be a $20.75 increase in out-of-pocket expenses for such a patient on an 80/20 plan.

Ambulance calls for the uninsured served 1,471 people in 2010: 1,206 were Elgin residents, 265 were not, and this group, representing 26 percent of the net billings for ambulance services in 2010, would be hit hardest by the increases.