A 911 call and a big bill

Family says they didn't realize trip to hospital would include paramedic; hospital offers discount and payment plan Franklin — Steve and Kelly Wronka ended up with more than they expected when they called an ambulance for their 3-year-old daughter Sarah recently. Although the ambulance came from Saint Clare's in Sussex, the Wronkas wanted her to been seen at Newton Medical Center. She was taken there and treated for complications from a urinary tract infection. It wasn't the ride, which gave them peace of mind, and carried their daughter quickly to receive crucial medical care, that caused the Wronkas concern. That's what they wanted. It was the price tag for that ride and the fact that one 911 call delivered not just an ambulance to their door. It also brought paramedics, who charged additionally for their services. And not everything was covered by the Wronkas' insurance. The couple questions also whether these extra services were required. Breaking it down The bill they received from Saint Clare’s Hospital for paramedic services alone totaled $3,170.80. After the Wronkas protested, the hospital told them they could pay it out over time — $46.95 a month for 24 months. But that amounts to $1,126.80, which is the contracted rate for their services for insurance companies. They were then billed that amount. The Wronkas asked themselves: How many other people have received unforeseen bills for medical services — and — were they responsible for the charges? The emergency call The Wronkas dialed 911 on the afternoon of Monday, Aug. 15, after Sarah appeared overly lethargic. She had been diagnosed with a urinary tract infection earlier in the day by her pediatrician. But now she had a fever of 102.7 and she stared listlessly out the living room window. With four other children at home, they decided to call an ambulance and get Sarah to an emergency room. Kelly Wronka described Sarah’s condition to the dispatcher as “non-responsive” and when the dispatcher asked if Sarah was breathing, replied, “Yes.” The dispatcher told her help was on the way. A Franklin Police Officer arrived on the scene. Then a person who, Kelly said, never identified himself showed up and asked her to sign a form. She thought he was a member of the local Wallkill Valley First Aid Squad. Although he didn't explain the form, she thought she was giving permission for the squad to transport Sarah to the hospital, and she signed it. The Ogdensburg First Aid Squad responded next. In a recent interview, George Sabourin, that squad’s captain, said Ogdensburg, Sparta and Hardyston have a mutual aid agreement and cover for Franklin when its squad requires assistance. Kelly now realized the initial emergency responder was a paramedic. He took an EKG — a heart test — and told Kelly that Sarah was “febrile.” Kelly asked what that meant; he said that Sarah had a fever. Kelly already knew that. The Odgensburg First Aid Squad transported Sarah to Newton Medical Center, with the paramedic and Kelly riding along. The paramedic hooked Sarah up to an IV, which Kelly said, disconnected frequently from her arm, its tube bending. The paramedic checked Sarah’s blood sugar, which was at a high level. Sarah, who had vomited at home earlier, complained of nausea while on the ride to the hospital, and the paramedic administered medication into her IV. Sarah was treated at Newton Medical Center, and released. The bill “It’s ridiculously outrageous,” said Steve Wronka. The Wronkas said they were never informed they would be charged for the paramedic’s services or for mileage. When they questioned the bill, Saint Clare’s billing department told them there would be little to no charge had they been transported to a Saint Clare’s facility. Kelly Wronka has since called Saint Clare’s to obtain her daughter’s medical records, and, has not yet received the consent form to acquire them. “I took my daughter to the Newton Medical Center via ambulance because I consider her a delicate child,” said Kelly. “Every time she gets sick it worries me because most of the time she ends up in the hospital. This experience has really put a sour taste in my mouth about calling an ambulance, how much are they going to charge me the next time?” This was not the first time the Wronkas had called an ambulance, but it was the first time they'd had a paramedic respond along with the transportation crew. Protocol “The dispatch center has certain written criteria, and they have to act,” said George Sabourin, Captain of the Ogdensburg First Aid Squad. A first aid squad's job is to provide "Basic Life Support" and a paramedic's function, he said, is to provide "Advanced Life Support." In an ambulance, paramedics are in touch with doctors at a hospital and get directives from them. “The first aid squad does not charge; it is a volunteer organization,” he clarified, then added: “The insurance should cover the paramedic charges — it is the emergency room brought to the patient.” But not every insurance policy does cover paramedics and not everyone has insurance. Jan Bednar is executive director of Saint Clare’s Emergency Services. She agreed with Sabourin's statement, noting that strict state guidelines dictate how calls are dispatched and that paramedics take orders from doctors while administering treatment. “It’s pre-hospital care, giving that person an advantage,” she said. “My paramedic made the right choice,” she added, in reviewing Sarah Wronka’s file and the care she received. “What the public needs to know is the paramedic services are not free.” Both Bednar and Stephanie Galloway, a spokesperson with Saint Clare’s, said they have not heard of an insurance company not covering paramedic services, and suggested the Wronkas file an appeal with their insurance company. They both said Saint Clare’s offers a self-pay discount, for which the Wronkas are qualified, offering a 79 percent discount for services. “We do work with our patients,” Galloway said. Bednar and Galloway also said the billing representative misinformed the Wronkas; the bill would be the same amount regardless where a paramedic accompanies a patient. “I would like to give the Ogdensburg First Aid Squad a donation, if I am not able to do so it’s because of the absurd amount I have been billed from Saint Clare’s,” Kelly said. anatomy of an ambulance call The 911 call is placed When a dispatcher is told, for example, a person has an altered mental state, difficulty breathing, chest pains, seizures, an allergic reaction or has been in a motor vehicle accident, a paramedic is also dispatched. Emergency personnel arrive on the scene. Paramedics wear an identifying badge, and typically, will also identify themselves. A paramedic will provide the patient, or, a person acting on the patient’s behalf, with a treatment consent form, and the patient or person acting on their behalf can sign a refusal form if they decline treatment. However, if a paramedic determines treatment is absolutely necessary, he or she can continue to treat. Paramedics follow treatment through to the hospital, accompanying the patient in the ambulance.