Fees for Arlington ambulance trips are going up in July, with baseline costs increasing to between $1,000 and $1,500.
The newly approved Fiscal Year 2026 budget will raise fees for transport to $1,000 for basic life support and $1,500 for advanced life support, plus $18 per mile. Current rates are $750 and $1,000, depending on the level of service, plus $15 per mile.
The higher fees are anticipated to bring in an additional $277,000 in the fiscal year that begins July 1. They’re expected to remain in place for three to five years.
“This is not a money-making effort. This is just trying to recover costs,” Fire Chief David Povlitz told County Board members during the recently concluded budget season.
Povlitz pointed to “the cost of medical supplies, the cost of doing business.” The cost of personnel is also set to rise significantly in the coming year as county officials attempt to recruit more firefighters and cover salary increases.
Prior to 1999, the county government did not charge for ambulance transport. Since fees were instituted, there have been five increases, the last in Fiscal Year 2023.
Ambulance fees impact people needing service in different ways:
- For those covered by Medicare, Medicaid and the military-health-care plan Tricare, the county government is reimbursed at a set fee from those insurers and does not bill any excess cost to the insured.
- People requiring transport and covered by private insurance carriers are billed for costs beyond what is reimbursed by their insurer.
- People without insurance coverage are billed directly.
People who are required to pay but unable to do so can apply for hardship waivers after receiving a bill. At the budget work session where the proposed increase was discussed, Board member JD Spain Sr., urged county staff to more prominently promote opportunities for a waiver.
“If you don’t know about the hardship waiver, next thing you know, something’s on your credit report,” he said.
The Arlington County Fire Department provided about 14,000 ambulance transports in Fiscal Year 2024, with need for emergency-medical services representing more than 60% of all department calls for service.
The number of transports declined during the peak Covid period but has since rebounded.
“More activity, more people in Arlington [equal] more incidents,” Povlitz said. “We just have more calls for service.”
In recent years, the County Board’s auditor looked at billing practices and then followed up with a determination that fire-department leadership had implemented recommended improvements.
In neighboring Fairfax County, members of a Board of Supervisors’ committee recently received an audit report focused on ways to recoup more costs.
For people with private insurance, Fairfax County — unlike Arlington — currently waives any costs not covered by the insurance provider for county residents, although it does bill non-residents for excess costs. Elimination of that benefit to residents is one option being considered by Fairfax leaders to recover more costs.
Nationally, about 15 million patients per year are transported via ambulance to medical facilities on an emergency basis, according to a study in the Journal of the American Medical Association. For the period in the study, about 33% of the trips were covered by Medicare, 31% by private insurance and 20% by Medicaid.
Under federal law, private and public ambulance services are not allowed to bill Medicare and Medicaid patients for excess costs of transport. That has proved challenging to some private ambulance services that are dominant in portions of the country, as the fees paid for Medicare/Medicaid patients typically are lower than the costs of providing service.
“The precise rates vary by state, but generally Medicaid pays out less than Medicare and both pay out less than the full cost of services, leaving [transport agencies] to cover the rest,” noted the Firefighters Support Alliance.
