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Area fire chiefs back ambulance fee

"The first question I get is, 'How much is this going to cost me?' Always. I'd like to be able to say, 'Nothing,' " Bernard said. For "core government functions - police, fire, rescue - there should be no barriers. None."

In Prince George's County, some of the stickier questions about who must pay and under what circumstances have been worked out with a somewhat flexible billing regime.

Insurance companies get bills, according to Prince George's Fire Chief Eugene Jones, while uninsured residents are billed directly. But that is not the end of it.

"We send you three bills," Jones said. "If the citizen chooses not to pay, they don't pay."

Unlike situations in some states where, for instance, an auto registration or some other official service could be blocked if a resident does not pay a bill, that's not how it works in Prince George's. "There's nothing connected to the bill, other than the request" for payment, Jones said. "That's the end of it."

Rubin described a similar philosophy for the District.

"Ours is a soft bill. There's not a real aggressive follow-up," Rubin said. "I'll leave it at that."

Rubin said there hasn't been much debate on the issue in the District, even when rates were raised recently, because the costs are almost all borne by insurance companies or the federal government through Medicare and Medicaid. Just "3 percent came out of anyone's family budget," Rubin said. Most of that was small co-pays, he added.

Rubin called the fee "the only responsible thing to do for our communities."

In Fairfax, as in the Montgomery proposal, the county waives co-pays for county residents, said Fairfax Chief Ronald Mastin.

"Our overall EMS call volume has not decreased since we introduced EMS billing in 2005," Mastin said. "It's really had no impact. It's been a win-win for us ever since we implemented it."

Billing for ambulance service has been most controversial in fire systems that have both career staff and volunteers, Mastin said, adding that Fairfax worked closely with its volunteers to get buy-in on the system.

Stafford chief Brown said "our volunteers have not seen any reductions . . . in any of their fund-raising efforts."

Prince George's also found a way around any political deadlock with its volunteer firefighters. The county allows volunteer companies to decide whether they will take part in the billing program. There are 38 volunteer companies, and 11 bill for ambulance service, just as career staff do, Jones said.

Under Montgomery's program, non-county residents without insurance would get a bill, but could have the fee waived under a hardship program covering those earning three times the federal poverty guideline or less. That's $32,490 for an individual, or $66,150 for a family of four.

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