toledoblade.com --

Strapped to a backboard as an ambulance races you away from a tangled traffic accident, you're probably not thinking about market shares, county contracts, and court filings. And when your heart's giving out as you dial 911, your first consideration is probably not the ambulance bill that might land in your mailbox in the coming weeks.

But six months after the four ambulance companies that serve Lucas County's Emergency Medical Services signed a contract agreeing to cap their billing limits to no more than $650, at least one of those companies is for the removal of those caps.

MedCorp says it's all about providing the best possible, life-saving service - an expensive business.

Its critics argue that it's about MedCorp's bottom line.

And caught in the middle are Lucas County residents who rely on 911 to call for potentially life-saving medical help.

"They [ambulance companies] have to look at it like a business, but we're looking at it as a service," said Gary Orlow, head of Lucas County's Emergency Medical Service.

The issue goes back to a struggle between MedCorp and the county over how much it bills its patients on emergency runs. When a resident calls 911, a Lucas County EMS dispatcher makes a determination on whether to send a basic or advanced life support squad, which are paid for with tax dollars.

If the situation is life-threatening, a county's first response unit might radio for an advanced life support unit, which is usually provided by one of four ambulance companies that contracts with the county. MedCorp is one of those companies. The others are LifeStar, Rumpf, and Promedica.

Basic life support offers first aid, while paramedics on an advanced life support call may do potentially life-saving procedures, such as administering medication or defibrillating a heart problem.

But in recent years, Lucas County officials began getting complaints from residents that they were being billed for advanced life support transportation when they needed only basic first-aid, which usually cost less than $500.

In contrast, an advanced life support transport from a traffic accident could top $1,000.

MedCorp owner Richard Bage said his company is relying on federal definitions for advanced life support when his company upgrades calls from basic to advanced. Because his rigs are usually equipped with paramedics who conduct patient assessments every few minutes, his costs are higher.

For the patient, it's a necessary cost, he argues. What appears to be a patient with minor injuries can suddenly deteriorate into life-threatening problems, like heart failure.

"If the county just wanted us to send basic EMTs out there, we'd virtually have nothing except blood pressure cuffs and a few Band-Aids," he said.

"If you have nobody there except a basic [and your condition suddenly deteriorates], you can do nothing but to pray to God and go like [mad] to the hospital," he said.

Indeed, the county and other ambulance officials concede basic runs sometimes turn into life-threatening emergencies, but they said that's a small percentage. In contrast, MedCorp was routinely upgrading their calls, Toledo Municipal Court Judge Francis X. Gorman recently found.

He recently ordered a Toledo woman's advanced life support bill from MedCorp reduced after a trial included testimony that another ambulance company upgraded its calls from basic to advanced less than 2 percent of the time.

The woman was involved in a traffic accident and complained of dizziness. She was transported to the hospital at a cost of $961. Judge Gorman, calling the bill "unconscionable," reduced her bill to $461.

He further ordered MedCorp to pay $5,000 in punitive damages, saying the company's propensity to upgrade its calls an "attempt to unilaterally modify the [county] contract."

Mr. Bage said he will appeal the decision. It's not about that particular run, he said. It's about being able to cover the costs associated with providing advanced life support on squads in case something goes wrong, he said.

So far, county officials haven't been convinced.

In December, commissioners forced a cap in billing in its renewed contract with the ambulance services - $500 for basic life support; and $650 for advanced life support. County officials told The Blade they have not received complaints of overbilling under the new cap.

But Mr. Bage said costs from gas prices to employees' health insurance have risen, and he stands to lose about $500,000 a year because of the caps. Most of that money, he said, would have been billed to insurance companies, not private citizens.

Earlier this month, the companies met with the county again, and MedCorp put forth the informal request to reconsider the billing caps.

Lifestar, Rumpf, and Promedica agreed their costs have gone up and said they will submit paperwork to support a possible lift or increase on the caps next year. Only MedCorp is pushing for a more immediate removal of the cap, Lucas County's Mr. Orlow said.

But county officials - many of whom saw copies of Judge Gorman's recent reprimand - may be balking at the request.

"The service [from MedCorp] is good, I don't want anyone to think they're not giving good service," said Commissioner Maggie Thurber, who has followed the debate closely and noted MedCorp has recently tangled with the county over another, unrelated, contract issue. "But it's a contract, and you can't expect three of four parties to follow a contract and the fourth to do whatever it wants."

Contact Robin Erb at: robinerb@theblade.com or 419-724-6133.

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