“But…I Can’t Afford An Ambulance!”

If you’ve worked in the medical transport business for any length of time, you’ve undoubtedly heard a patient express their concern about the very real expense of medical transport. It’s an awkward moment.  Patient’s don’t usually start there day with expectation of being transported in an ambulance to the hospital. Nobody writes, “Get in a minor traffic accident and have neck pain.” on their to-do list in the morning.

So, what do we do when patients express concern over the cost of ambulance transport? It’s probably something that you never encountered in your EMT training or even your field internship. The truth of the matter is that we often handle this moment poorly.

The idea that a patient who recognizes the need for medical care would refuse our services can often catch us off guard. Our response can sometimes be curt and dismissive. What we say next is an issue that treads such a delicate ethical line that few EMS educational forums are willing to tackle the subject. Now let me give you the straight dope. There is no single right response to this statement. I can’t tell you any secret magic words that will alleviate your patient’s concern. What I can do is give you some guidelines and perhaps a few starting points.

Here are

1) Recognize that the patient has a legitimate concern.

Often, our first instinct is to dismiss the patients concern. It’s an awkward topic and we rush to move off of it with phrases like, “Let’s worry about you first and then we will worry about that later. But “we” really won’t worry about it later. The patient will. When the bill for our services arrives, we will be long gone. And the patient will have to cope with how to pay.

Instead of dismissing the concern, pause and consider what the cost of ambulance transport really means to the patient. Then tell them the truth. It’s OK to say, “It’s true John, ambulance transport is expensive. The tests and treatments that we provide are expensive. And I wouldn’t recommend them if I didn’t think that they were important right now.” Recognizing that the patients financial concerns are real and legitimate allows you to honestly speak about your concerns as well.

2) Be honest about the true risks to the patient.

We are professionals. We’re trained to assess people and recognize the probabilities and possibilities associated with their complaints. We can be honest and forthcoming about our thoughts and concerns. The patient needs to be advised of the real risks and real possibilities for them to make an informed decision. This isn’t a scare tactic; it’s your legal obligation. Actually, that’s incorrect. It’s only a scare tactic if you make it one.

When you’re advising the patient of the risks and possibilities, you need to do a gut check and make sure you have the patients best interests in mind. If there are significant risks to the patients health, then say so. But there are lines.

It’s OK to give the patient with aching chest pain the hard sell about myocardial infarction and cardiac arrest, but when the advisement for a cut finger turns to talk about septic shock, we’re transitioning from patient care to sales. Your patient trusts you to be their advocate. Make sure you remain their advocate. Don’t let anyone, or any outside concern, compromise that relationship.

3) Ask about the patients health insurance options.

Some patients may not recognize that your care is also covered by their medical insurance provider. If they are concerned about paying for your services, it’s acceptable to remind them that their medical insurance may cover all or part of the ambulance bill. Remember that you aren’t privy to the details of the patients insurance coverage. While it’s not a bad idea to be familiar with what kinds of services common insurance plans cover, you shouldn’t make any committing statements about what is and is not covered by the patients insurance.

(Click here for more information on private health care insurance.)

If the patient has private healthcare insurance, it’s OK to say something like, “Steve, it’s impossible to say with certainty that your insurance provider will cover our services, but ambulance transports are covered in most standard health insurance packages.”

4) Focus on the value of good health.

Good medical care can be expensive, but poor health can be even more pricy. Sometimes it”s helpful to remind people that most medical concerns only become more expensive the longer they allowed to progress untreated. If the underlying medical condition could cause a lifelong disability, that could affect the patients ability to do their job long term. These are valid concerns that the patient may not consider while mulling over the hefty price of ambulance transport.

5) Guide the patient towards legitimate alternatives.

Just because the patient refuses ambulance transport doesn’t mean that you need to throw your hands up and leave them to fend for themselves. You are still the patients advocate. Explore the safest alternatives to ambulance transport for the patient. Are they willing to be seen at the emergency room on their own? If they are unwilling to go with you, is there someone else who is available and willing to transport them? Do they have directions to the most appropriate medical facility? Under what conditions should they call 911 again? (Make sure the person who will be with the patient knows these criteria as well.)

The overall concern is getting the patient the most appropriate medical treatment that they will accept while respecting their rights and acting as their advocate. The, “I can’t afford this!” challenge will undoubtedly occur again in your EMS practice. Probably sooner rather than later. I wish you well.

Now it’s your turn: What do you say to people when they say that they can’t afford your care? Leave us a comment and join the discussion.

Comments

  1. It is a tough subject. My parents have dealt with this and their experience guides the way I approach it. And I have come across many, many people that do not have the money for healthcare, emergent or otherwise. Sometimes, honestly, it runs me afoul of policies and protocols, but it is what I do anyway. Plus, most employers I have ever worked for actively discourage us from talking about costs, but I know that in the real world, it matters. It matters to me.

    First, I NEVER come off with the line “Let’s worry about you”. They ARE worrying about them and their ability to pay for all of this “life saving” care we want to provide. You are right, when the bill comes, I will be long gone.

    Second, I explain honestly what I have found, in terms they can understand, and I tell them my opinion of the realistic consequences. And I am not afraid to tell them “This can kill you” if in fact I think it might be True. I try to avoid “doom and gloom” predictions about how lethal that knee abrasion or runny nose and sore throat may actually be.

    Third, I try and provide options. Sometimes there are no options. But if there are, I try to provide them.

    It is a fact that some people do worry about paying their bills, including healthcare bills. Many of our elderly feel that they HAVE to pay their bills, and maybe things like buying their medicine or even eating are considered optional. I have seen this first hand.

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