Cranberry Township EMS estimates it won’t receive any payment for around 13% of its calls each month. Superior Ambulance Service estimates it averages around 100 calls per month that never result in payment.

Some decline a ride in the ambulance after calling for help. Others won’t pay their bill afterward.

Ambulance services don’t even recoup the total costs associated with the majority of calls that do result in some payment — mostly ones for patients on Medicare and Medicaid. Even when they require an emergency ride to the hospital.

“It’s becoming more and more difficult because it’s costing more and more to provide the service. (More) than we’re getting reimbursed for,” said Superior Ambulance Service Chief Doug Dick.

The cost of “being ready” adds up fast for ambulance services that see expenses rising while they were already surviving on shoestring budgets.

Everyone counts on a hasty response when calling 911, but the leaders of Butler County EMS providers say they desperately need — but can’t count on — payment for their services.

The insurance reimbursement rate for Medicare and Medicaid sits around 34% after contractual obligations are paid, according to multiple EMS leaders in the county.

That means if Cranberry Township EMS charged about $1,341 for transport, government insurance would only pay $456, which is the EMS company’s average reimbursement per billable trip.

For Cranberry EMS, 73% of its patients use Medicare or Medicaid, Matt Nickl, executive director, said. For nearby Quality EMS, located in Adams Township and serving the surrounding area, it’s more than 60% of patients, according to Chief Conrad Pfeifer. For Superior Ambulance, about 78% of the people it serves use Medicare or Medicaid.

“Reimbursements need to increase,” Dick said. “EMS needs to actually be paid for the services they provide.”

Freeport EMS Chief Jamison Hughes said the average revenue per run across insurances is around $592.

“It doesn’t meet the requirements that we need to have the staffing that we need,” he said.

Most of those not covered by government programs have private insurance that can be balance-billed, meaning the ambulance service can ask for more money from patients after the insurance paid its requirement. This can’t be done for Medicare and Medicaid.

If insurance doesn’t cover the total costs of the trip, the ambulance service bills the patient to cover the gap.

Rather than making only $456 for a $1,341 transport, the average amount the agency receives for its care could creep closer toward the total expense.

Most of the time, it’s about 110% percent of what Medicare and Medicaid pay, Dick said.

Because places like Highmark and University of Pittsburgh Medical Center send a check to their client for the amount it will pay the ambulance service, those payments don’t always make it back to the provider, Dick said.

Lawsuits can be filed if a patient does not deliver the check to the ambulance service.

Each ambulance service also has a percentage of its customer base that is uninsured. The ambulance services are still required to respond for those residents in an emergency.

“We do our best to try to collect, but at the end of the day, it becomes very difficult to get money,” Hughes said.

Slippery Rock Volunteer Fire Company and Rescue Team has also expressed difficulty in getting customers to pay their bills, said Chief Ryan Hanchosky.

The rescue team has filed 10 lawsuits this year against people who did not pay. Half of them were for more than $1,000.

Dick said Superior Ambulance Service opts not to sue because, in his experience, district judges will often set a minimal monthly payment that doesn’t sustain the ambulance service.

“You’re not gaining anything,” Dick said.

Instead of suing, Cranberry Township EMS sends around $20,000 in unpaid bills to collections each month, Nickl said. He added unpaid bills over $500 can be factored into credit reporting.

Cranberry Township EMS attempts to recoup some of those costs by adding a lesser fee scheduled for minor calls, such as lift assists. The company charges $137.50 for list assists for non-members.

Nickl said a high percentage of customers are willing to pay the fee.

“It’s not a big bill, but we’re rendering a service, so we expect to get paid,” Nickl said.

There’s staff and resources used every time an ambulance is requested, but most EMS companies receive nothing for call cancellations and from patients who are evaluated at the scene but decline transport to the hospital.

“EMS only gets paid for transporting a patient to a hospital,” Dick said.

Superior Ambulance Service, which is based in Mercer County but serves parts of Butler County, categorizes lift assists — the ones Cranberry Township has started charging for — as a refusal since the patient wasn’t transported and doesn’t collect any money.

EMS is being paid for transportation under the current business model, not medical care, Dick said.

“We need to be reimbursed for the care we provide,” he said.