Ticonderoga EMS receives contracted monies allotted by the Towns of Ticonderoga, Putnam and Crown Point on a yearly basis. The remainder of the operating budget is made up by revenue recovered through billing for ambulance services provided. Unfortunately, we are unable to recover 100% of the total cost of our services strictly through billing of Medicare, Medicaid, Commercial Insurance and direct payment from patient.

More than 25% of our total call volume is not chargeable to either the patient or insurance companies.

Quite simply, yes. Without paying for ambulance service the availability of adequately trained staffed ambulance would decrease drastically. Ambulance transport is covered under most insurance plans (please refer to your insurance plan summary). Additionally, under Medicare guidelines, we must make every effort to collect all unpaid fees. This is to ensure a ‘standard practice’ of collection is in place, as opposed to showing favoritism to any specific individual.

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However, we also understand that sometimes the patient or their family just cannot meet their obligations to pay this amount immediately due to financial hardship. With this in mind Ticonderoga EMS does offer assistance if needed.

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If you need assistance paying your ambulance bill, please contact us for a hardship application or payment arrangement.

No, most insurers like Medicare will only pay their one set of rates regardless of the amount billed. It will make the difference go up a lot but won’t change the amount we receive. It would affect those that are still uninsured or underinsured who do not have ambulance coverage and pay out of pocket. We try to negotiate with large commercial insurers whenever we can.

Ambulance charges are based on the level of service furnished as well as loaded mileage, not simply on the vehicle used.

Basic Life Support (BLS)

Basic Life Support (BLS) is transportation by ground or water ambulance vehicle and includes the provision of medically necessary supplies and services.

Advanced Life Support - 1 (ALS1)

Advanced Life Support includes the provision of medically necessary supplies and services and the provision of an ALS assessment or at least one ALS intervention (procedure performed by an EMT-Intermediate or an EMT-Paramedic in accordance with State and local laws).

The assessment is performed by the crew as part of an emergency response. This is necessary as the beneficiary's reported condition, at the time of dispatch, indicates that only an ALS crew is qualified to perform this assessment.

The result of an assessment does not necessarily determine that he/she requires this level of transport.

When dispatched appropriately and the ALS crew completes the assessment, the ambulance services provided are covered at this level as long as the transportation itself is medically reasonable and necessary and all coverage requirements are met.

Advanced Life Support - 2 (ALS2)

Includes the provision of medically necessary supplies and services, which include:

• At least three separate administrations of one or more medications by intravenous (IV) push/bolus or by continuous infusion (excluding crystalloid fluids) or

• At least one of following ALS2 procedures: Manual defibrillation/cardioversion, Endotracheal intubation, Central venous line, Cardiac pacing, Chest decompression, Surgical airway, or Intraosseous line

The following does not determine and ALS2 Medications (oral, injections, nebulized), crystalloid fluids, 5% dextrose in water (D5W), saline, lactated ringers, oxygen, and aspirin.

Specialty Care Transport (SCT)

Includes the provision of medically necessary supplies and services at a service level above the scope of an EMT-P.

This type of transport occurs when a critically ill or injured beneficiary is transported from one medical facility to another because his/her condition requires ongoing care furnished by one or more professionals in an appropriate specialty (such as emergency or critical care nursing, emergency medicine, respiratory or cardiovascular care, or an EMT-paramedic with additional training).

If EMT-Paramedics are without specialty care certification or qualification and are permitted to furnish a given service in a state, then that service does not necessarily qualify for SCT and may be downcoded to a lower level.

Paramedic Intercept (PI)

Paramedic Intercept services are ALS services provided by an entity that does not provide the ambulance transport. This type of service is most often provided for an emergency ambulance transport in which a local volunteer ambulance that can provide only basic life support (BLS) level of service is dispatched to transport a patient. If the patient needs ALS services such as EKG monitoring, chest decompression, or I.V. therapy, another entity dispatches a paramedic to meet the BLS ambulance at the scene or once the ambulance is on the way to the hospital. The ALS paramedics then provide services to the patient.

Refusal of Medical Aid (RMA)

All adults with decision-making capacity (i.e. able to make decisions for themselves) have the right to accept or decline medical treatment—even if decisions may result in a poor outcome, including death.  This fundamental right to refuse medical treatment is considered a negative right—the right to not be touched and to be free from unwanted medical interventions.  Overriding a decisional patient’s refusal is not ethically or legally permissible.

Even adults who lack decision-making capacity retain the fundamental right to refuse recommended treatment. Health care professionals are required to respect their refusals, except in limited circumstances as outlined below.

In ethics terms, treatment given over objection violates the ethical guideline of respect for persons and can only be justified in specific situations.

Decision-making capacity (i.e. the ability to make one’s own decisions) is a clinical determination that refers to whether a patient has the mental capability to:

• Understand relevant information,

• Appreciate the medical situation they are in and its possible consequences,

• Reason through risks, benefits and alternatives of treatment options, and

• Communicate a choice freely and voluntarily based on their own values.

Only adults with decision-making capacity are able to provide informed consent or an informed refusal.