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Va. city officials begin first steps to create a ‘compassionate’ ambulance billing system

Virginia Beach officials look at EMS billing as operational costs double and fundraising declines

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A Virginia Beach Volunteer Rescue Squad ambulance sits on the front ramp at their station off of Old Donation Parkway in Virginia Beach on Tuesday, Nov. 26, 2024.

Kendall Warner / The Virginian-Pilot

By Stacy Parker
The Virginian-Pilot

VIRGINIA BEACH, Va. — The wheels are in motion to bill patients who use the city’s ambulance service. On Tuesday, the City Council approved the start of administrative preparations for a “compassionate” Emergency Medical Services billing program.

A final say on whether to initiate a billing program will come in May when the council votes on the fiscal year 2025-26 budget.


Ambulance services cannot afford to feed the billing department incomplete, inaccurate or misrepresented information

Compassionate billing aims to limit a patient’s out-of-pocket expense or to eliminate it entirely. The parameters of the program that Virginia Beach is exploring have not been specified.

Virginia Beach’s EMS is a combined system of paid city employees and volunteer rescue squad members. The general fund and donations help support it.

Virginia Beach is the only city in Hampton Roads that doesn’t bill for ambulance service.

Costs to operate the system have nearly doubled over the last few years, and at the same time, fundraising has been declining. Billing patients’ health insurance could provide more than $14 million a year, according to a recent feasibility study.

Private insurance plans tend to cover at least 80% of the cost for ambulance transport. Under that scenario, if the city charged $1,000 for advanced life support transport, a private insurance plan would cover $800 and a patient’s copay would be $200.


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Caps limit what can be charged to Medicaid and Medicare patients. The cap for Medicare patients is $687 and the cap for Medicaid is $280, according to the report.

No patients would ever be denied services, and there would be no charge for emergency medical care if a patient is not transported by an ambulance, EMS chief Jason Stroud has said.

Over the next several months, city staff will conduct a public education campaign, draft policies related to billing and work to establish a process to partner with a third-party billing company.

It will take six to nine months to initiate EMS billing, if approved, according to the city.

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