Nice to see more communities moving toward basing their ambulance fees on the cost of service delivery.
This is something we encourage to help with EMS system sustainability. Medicare and Medicaid patients are essentially unimpacted by changes in fees, and the reality is that collections from self-pay patients are very low (our soon to be released December 2025 EMS Financial Index will show a 7.3% self-pay gross collection rate for public providers). Self-Pay patients can be shielded from large out of pocket expenses through compassionate care billing practices.
Here’s a link to a recent PWW Advisory Group webinar on this topic: 𝐖𝐡𝐚𝐭 𝐀𝐫𝐞 𝐘𝐨𝐮 𝐖𝐨𝐫𝐭𝐡? 𝐄𝐬𝐭𝐚𝐛𝐥𝐢𝐬𝐡𝐢𝐧𝐠 𝐚𝐧 𝐀𝐩𝐩𝐫𝐨𝐩𝐫𝐢𝐚𝐭𝐞 (𝐚𝐧𝐝 𝐂𝐨𝐦𝐩𝐥𝐢𝐚𝐧𝐭) 𝐅𝐞𝐞 𝐒𝐜𝐡𝐞𝐝𝐮𝐥𝐞: https://info.emsmc.com/webinar-what-are-you-worth
Feel free to contact us if you would like to learn how to model the impact that fee schedule changes could have on your EMS system.
𝐊𝐞𝐲 𝐐𝐮𝐨𝐭𝐞𝐬 𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐑𝐞𝐩𝐨𝐫𝐭:
“The city plans to raise ambulance rates from $735 or $1,065 to $2,324 for advanced life support calls, and $620 to $1,162 for basic life support calls.”
“The new rate is based upon the “true cost” of the service as determined by a third-party auditor, a rate the city already uses to get additional federal reimbursement for Medicare and Medicaid clients.”
“Dubuque’s current ambulance rates are comparable to charges levied by other cities in Iowa, but cities in other states, particularly Illinois and Wisconsin, have already moved to charging ambulance users the full cost of the service, rather than falling back on property taxes.”
“These communities have also shifted the burden of paying for fire departments away from the community at large and onto the person who uses the service.”
“For that self-pay group, the city offers a hardship waiver both for residents and non-residents, which Scheller said would be extended to people charged for other Fire Department services.”
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𝐂𝐢𝐭𝐲 𝐨𝐟 𝐃𝐮𝐛𝐮𝐪𝐮𝐞 𝐬𝐞𝐞𝐤𝐬 𝐭𝐨 𝐫𝐚𝐢𝐬𝐞 𝐚𝐦𝐛𝐮𝐥𝐚𝐧𝐜𝐞 𝐟𝐞𝐞𝐬, 𝐜𝐡𝐚𝐫𝐠𝐞 𝐟𝐨𝐫 𝐬𝐨𝐦𝐞 𝐅𝐢𝐫𝐞 𝐃𝐞𝐩𝐚𝐫𝐭𝐦𝐞𝐧𝐭 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬
BY CHRIS GRAY
Nov 29, 2025
https://www.telegraphherald.com/news/tri-state/article_3e7caa05-8fb1-453b-8545-f3cb943dbbbd.html
City of Dubuque leaders seek to sharply increase ambulance fees and begin charging for a menu of Fire Department services, including dousing vehicle fires.
The new user fees and increased ambulance rates would allow the city to recruit and hire five new firefighter-paramedics as early as April.
The Dubuque City Council will consider a proposal for the new fees and added positions at its Monday, Dec. 1, meeting.
The city plans to raise ambulance rates from $735 or $1,065 to $2,324 for advanced life support calls, and $620 to $1,162 for basic life support calls.
“We are looking to charge the full cost of our service to all pieces of our payment mix,” said Fire Chief Amy Scheller, explaining the new ambulance rates.
Current rates have been billed based on what major insurers were willing to pay for the ambulance services and then spread out across other insurers and residents who self-pay.
The new rate is based upon the “true cost” of the service as determined by a third-party auditor, a rate the city already uses to get additional federal reimbursement for Medicare and Medicaid clients.
Dubuque’s current ambulance rates are comparable to charges levied by other cities in Iowa, but cities in other states, particularly Illinois and Wisconsin, have already moved to charging ambulance users the full cost of the service, rather than falling back on property taxes.
“It’s not just an Illinois model, it’s across the country,” Scheller said. “Fire departments will look at the user to cover the cost of the service.”
These communities have also shifted the burden of paying for fire departments away from the community at large and onto the person who uses the service. Some communities charge for house fires, but Scheller’s recommendation declined to add a fee for this service.
New Dubuque Fire Department charges have not been set, but a third-party fire cost recovery recommended $520 per auto crash, $605 per vehicle fire, $700 for hazardous material cleanups and $400 for rescues.
The new ambulance rates are expected to net an additional $1 million per year, and the new fire charges would bring in about $120,000. A renegotiation of an auditing contract reaped $78,000 in savings, leaving about $1.2 million to hire five new firefighters. The cost estimate for a new firefighter is $108,000, with a starting salary of about $70,000.
City Manager Mike Van Milligen has the authority to raise ambulance rates, but he would need authorization from the City Council to create five new firefighter positions as well as impose the new Fire Department cost recovery fees.
Mayor Brad Cavanagh said he was still working out his position but noted that ambulance rates had not been raised for 10 years, and an increase was overdue to cover the rising costs of the service. He also said there should be some balance between property taxes and user fees.
“We all have a desire to add these firefighters,” Cavanagh said. “This is a conversation about how we do it.”
Outgoing Council Member Ric Jones, a retired firefighter, said he is glad Scheller came forward with a concrete proposal to bring the city closer to its hiring goals for the Fire Department. He thought insurance companies would pick up many of the increased fees and new charges, but he drew the line at charging to extinguish vehicle fires.
“I’m not sure I agree with charging for putting out fires. I think that’s a basic tax-supported service,” Jones said.
But both incoming council members — who will be sworn in in January — rejected the plan and one sitting council member, Danny Sprank, said he was opposed to shifting so much of the burden for paying for the Fire Department to citizens who need its services.
“I don’t agree with that much of an increase,” he said. “That’s a pretty big jump — $2,300 to $2,400, that’s not exactly affordable for those who need it.”
He also thought auto insurers would balk at paying for the Fire Department to respond to crashes and put out fires.
“Citizens already pay taxes for our Fire Department,” he said. “I don’t think additional fees for a service that is out of your control is fair for our citizens.”
Council Member-elect Chris Staver agreed: “That seems like a bad idea. That seems like a way to promote people not to call the Fire Department. I think that’s what our taxes are for. They need to find it in the budget.”
Staver said he understood that ambulance fees might be overdue for an increase but opposed the sharp rise.
Council Member-elect Tyson Leyendecker said money for the Fire Department should come from a reprioritization of spending rather than heaping new fees on citizens.
“It’s double taxation, right?” he said. “I would think there’s a better solution than that.”
The new ambulance rates would primarily affect patrons who self-pay for the service, who are either uninsured or underinsured with a high deductible to pay before their insurance kicks in for the coverage.
The city might recover more money from insurance companies, but it cannot balance-bill the patient and seek more money than the insurer agreed to pay. People with insurance from Medicare or Medicaid would not see a bill, and the department already has a method to extract the actual cost of services from the federal government.
For that self-pay group, the city offers a hardship waiver both for residents and non-residents, which Scheller said would be extended to people charged for other Fire Department services.
The waiver works on a sliding scale. Households below 150% of the federal poverty level get a complete waiver, while those up to 300% of the poverty level can receive a reduction. The higher figure works out to $47,000 for a single person or $96,000 for a family of four.
Under the current fee schedule, the hardship waiver has rarely been used; Scheller said the department is currently processing one application, which would be the first sought and granted since 2022.
Scheller is also supporting a federal grant proposal that would help the city staff up to nine more firefighters over three years, helping to make good on a top council priority of increasing minimum staffing on all fire rigs to three firefighters, up from two firefighters currently.
The grant would have a 25% local match for the first two years and a 65% match for the third year, allowing the local government to ramp up budgeting for the added cost of the new employees so it would be sustainable when the grant ends, Scheller said.
