While insurance can be helpful to many dealing with a medical dilemma, many of those on hand at Monday's emergency services summit said collecting money from companies is difficult, while paying their own bills is an increasingly burdensome expense.
"Is insurance that bad all over?" asked Town Councilman James T. Smith to fire chiefs and other representatives from Morley, Canton and Rensselaer Falls fire departments.
The response was a resounding yes.
Canton reported that 30 percent of its overall budget at the fire department went toward paying its insurance, while Morley Fire said the roughly $14,000 it pays accounts for approximately 33 percent of its budget. Rensselaer Falls' insurance expenses eats about 22 percent of its yearly budget.
Canton Fire Department Second Assistant Chief Russell B. Lawrence IV explained that risk pools for fire departments in the area are determined by geography and that every time there is an incident where a local department needs to make a claim, everyone's insurance costs increase. After a claim is made, prices go down slowly.
"It's like gas, it doesn't go down nearly as fast as it goes up," Mr. Lawrence explained.
Canton Fire Chief Brian McCluskey also said the increasing price of fire equipment causes insurance prices to rise.
"Equipment is going higher and higher. Value is going higher and insurance is going up and up because of that," he said.
On the other hand, getting insurance companies to pay for services used by their clients is becoming increasingly arduous.
According to Rensselaer Falls EMS Captain James Blackburn, a new medical necessity rule is coming into play that insurance companies lean on to avoid paying for ambulance rides.
"Depending on who the insurer is - Blue Cross Blue Shield is notorious for lots of things - Blue Cross Blue Shield is going to determine if this is a medical necessity and that an ambulance was actually needed on a trip to the ER," Mr. Blackburn said. "Essentially, they are being allowed to determine whether we get paid or we don't get paid and how much we actually get paid."
The new restriction is bringing to light the issue of abusing the 911 system, according to the EMS Captain.
"There is this belief that if you call EMS, you get priority at a hospital and that is not the truth," he said. "A lot of us when we are transporting patients and we think that they are capable for triage - it's just a 'booboo,' it's a sprain - we do not need to use a bed in an emergency room for someone who could have gotten in their own car or called somebody instead of calling an ambulance and putting hundreds of thousands of dollars worth of equipment on the road."
The abuse problem is also being used by some to gain access to insurance money.
Mr. Blackburn continued by explaining that Blue Cross Blue Shield typically does not like to pay emergency responders directly. He said the company will send a check to the consumer for emergency room visits and for rescue squad calls.
"You have the repeat offenders who go to the emergency room and then they wait for a check. It is ironic and it is sad but it does happen and they can't refuse care and they know that. So if they go to an emergency room and rack up a $1,800 bill, they just sit at home and wait for the check to show up and they are good to go," Mr. Blackburn explained.
When asked by town officials if responders could determine whether or not to transport someone, Mr. Blackburn said no.
"Then you are leaving this up to a diagnosis and none of us are allowed to diagnose, including dispatchers. If you call the 911 system, it is designed for answering that call whatever the case may be. If they stub their toe and they want an ambulance, we are going to dispatch an ambulance," he explained. "We could go there and try to talk them out of using an ambulance for a stubbed toe, but ultimately at the end of the day I cannot refuse care to you just because I know you are abusing the system."
Town Councilman Philip K. LaMarche and Town Supervisor David T. Button both inquired about the use of a third party collection agency on billing. Mr. Blackburn said that idea is something the department has been hesitant about.
"It is not beneficial. You will get more money perhaps in the long run, but then you turn us into something we don't want to be," he explained. "It is my experience that most agencies do not use collection agencies unless they are much larger."
"If we have no means of discouraging certain behaviors and we have no tools other than billboards that say 'you really shouldn't do this,' I don't know if that is going to work," Mr. LaMarche interjected.
Mr. McCluskey said Canton also does not use a third-party collection agency, but did not rule it out for the future.
"It may come to that point. It is an option that is not shut out," he said.