In the state and national health care debate, one issue keeps coming up. Medical providers cannot refuse to treat patients with emergencies, and yet many patients don’t have health insurance. How do hospitals, doctors and emergency medical services collect from the people who can’t or won’t pay?

One small town fire and EMS department’s solution? Take them to Small Claims Court. 

Last week, Ninilchik Emergency Services, the department serving the Ninilchik area 40 miles north of Homer, did just that, suing 17 patients — one who got treated twice — for past-due bills totaling $20,000. Most of them are for a $1,000 ambulance call and transportation 40 miles either way to South Peninsula Hospital in Homer or Central Peninsula Hospital in Soldotna at the rate of $11 mile.

Ninilchik EMS board treasurer Lloyd Taggart said he filed the small claims suits at the direction of the board. 

“It’s a first time for doing this,” he said. “It’s something we didn’t want to do, but it’s something we felt like we had to do.”

Unlike the Homer Volunteer Fire Department or Kachemak Emergency Services, Ninilchik Emergency Services isn’t supported by taxpayer money. For example, much of KES service area budget comes from money collected through property taxes. 

Ninilchik does not have a service area.

“We’re not a free service,” Taggart said. “It’s all donations. We depend on money from ambulance runs and the membership drive.”

For patients with insurance through Denali Kid Care, Medicare, Medicaid and private insurance companies, Ninilchik, like Homer and KES, bills those companies. In Homer the city finance department does the billing. In the borough, a third-party billing company bills insurance companies.

If there’s no insurance, for Ninilchik, the patient gets billed. Taggart said many patients have worked out payment plans. That’s OK.

“The ones that don’t have it, they make payments,” he said. “We’re not hard nosed about them.”

For the batch of 17 patients being sued, Ninilchik Emergency Services made repeated requests for payments. It sent letters. It sent certified letters. It sent registered letters. The patients didn’t respond. Taggart said if they’d offered to make payments, none of the defendants would have been taken to court.

“We’d take it,” he said. “We’ve got people who are paying $5 a month. That’s all they can afford. We accept it.”

Ambulance services for the Homer Volunteer Fire Department are set by city resolution. Basic Life Support (BLS) calls are $440, and Advanced Life Support (ALS) calls, such as heart attacks, are $550. Mileage is $7.50 a mile. That’s comparable to the KES ambulance rates of $300 for Basic Life Support, $500 for Basic Life Support-Emergency and $400 for Advanced Life Support. Mileage is $11 a mile or $7 a mile for more than 17 miles. For KES, a medevac is $3,500 per hour plus a fuel charge. 

A medevac bill through a private air ambulance like LifeMed can be as much as $38,000 from South Peninsula Hospital to an Anchorage hospital.

Although most of its operations are paid for through service area property taxes, KES Assistant Fire Chief Steve Boyle said the ambulance fee is for additional, as-needed services such as oxygen, medicine and medical supplies. The service area tax is for having a fire and emergency service ready to respond. 

“Some of that billing cost is to recoup the usage of the ambulance,” he said. “Taxpayer money it to have it ready to go.”

When ambulance patients don’t pay their bills, the third-party billing company attempts to collect. The borough won’t take patients to Small Claims Court, said Craig Chapman, borough finance director.

“The issue with Ninilchik is they need fees,” he said. 

The city of Homer will send past-due bills, including ambulance fees, to a collection agency after 90 days or three billing cycles, said city finance director John Li. The city will work out a payment schedule, too. It also doesn’t take past-due accounts to Small Claims Court.

Taggart said the batch of about $20,000 past-due bills is only a small part of what Ninilchik is owed. 

“That’s not even half of them,” he said. “That’s what the board says — we will approve this many (to take to small claims). We’ve got years and years we haven’t been paid that we’re not even going after.”

Taggart estimated that over the years there has been at least $100,000 owed the emergency services for ambulance calls.

Taggart said that in some cases of the people being sued, the patient would have died if emergency medical technicians hadn’t responded. The calls ranged from Basic Life Support to Advanced Life Support. One call was for a woman bitten by a bear. She’s being sued for a bill of $1,451.

“We cannot refuse to respond,” he said. “We have to respond.”

So why sue someone who probably won’t be able to pay even if a judge issues a judgment? Four words: Alaska Permanent Fund Dividend. If Ninilchik Emergency Services prevails in its claims and can get a case number showing so, it can put a claim against the patient’s Permanent Fund Dividend. 

“I don’t know how far we will go or how much if any we’ll get back,” he said.

Michael Armstrong can be reached at michael.armstrong@homernews.com.