CAL FIRE/Riverside County firefighter/paramedic Juan Gonzalez cleans a vehicle at Palm Desert Fire Station No. 33 (44400 Town Center Way) during some down time. Credit: Maria Sestito

When someone doesn’t have health insurance or can’t afford their deductible, it often results in fewer doctor visits and later diagnoses of severe conditions. It’s easy to assume, however, that in a medical emergency, the same person would call 911 despite the cost.

Unfortunately, that’s not the case.

Calling the ambulance can indeed cost you. In the Coachella Valley, a ride to the hospital via ambulance starts at about $1,200—and that’s before additional costs like mileage, oxygen use and other surcharges are added in.

In the “Cove Communities” of Rancho Mirage, Palm Desert and Indian Wells—three of the Coachella Valley’s wealthier communities—residents don’t have to worry about these costs: Getting to the hospital or receiving on-the-spot life-saving care won’t cost them.

Thanks to the Emergency Medical Services Insurance Billing Program, which went into effect in 2017, residents aren’t held responsible for any amount left unpaid by insurance companies for emergency paramedic or ambulance transportation services. That means that residents don’t have to worry about paying out of pocket, even if they’re uninsured or have large deductibles.

I live in Palm Desert, and my household recently benefited from this program. Following the hospital visit, my household member received a letter from the city informing him of the program—although he already knew about it through me. I knew about it because, when I lived in nearby Rancho Mirage, my apartment manager told me about it.

All this made me wonder if my neighbors knew about this—and if other parts of the Coachella Valley were doing anything similar.

Indian Wells, Palm Desert and Rancho Mirage formed the Cove Communities Services Commission in order to provide coordinated and effective responses to public-safety incidents while also being cost-conscious.

“What happens is, we contract with a third party for the billing, so when info gets out, we try to recover what we can from insurance. Whatever we can’t recover, we just write-off,” said Jacob De La Cruz, financial analyst for the city of Rancho Mirage. “We don’t collect on it. We don’t pass it on to residents.”

All three cities have services provided by CAL FIRE/Riverside County Fire Department, which is paid for through the fire-tax fund, De La Cruz said. Third-party billing services for the Emergency Medical Services Insurance Billing Program, on average, cost Rancho Mirage between $6,000 and $8,000 per month; this is also paid for through the fire-tax fund, he said.

The base rate for emergency services in the Cove Communities is $1,464.11. Beyond the base rate, additional charges might include a $28 per-mile fee, and $132 for the use of oxygen. If no one is transported, but medical care is provided, there may be a $425 “dry run” fee. But residents don’t have to ever worry about paying any of these fees.

Residents in the valley’s other six cities aren’t as fortunate. The Indio Fire Department is also staffed by CAL FIRE/Riverside County Fire, and emergency rates there are less—with a $1,200 base rate, $22 per-mile fees, a $115 surcharge for night calls, and $120 for dry-run calls—but uninsured or underinsured residents are expected to pay.

American Medical Response representative Nicole Michel pointed out that the pandemic had a negative impact on the industry, leading to staffing shortages across the U.S., including at AMR.

Palm Springs, Desert Hot Springs, La Quinta, Coachella and unincorporated areas of the Coachella Valley get emergency medical services through American Medical Response (AMR). Riverside County’s contract with AMR is in effect until June 30, 2026. AMR is a private, for-profit company; according to its website, it’s the nation’s largest private provider of medical transportation services.

A 2019 analysis by The Desert Sun found base rates for AMR response throughout Riverside County were about $1,798. In fiscal year 2021-2022, those emergency rates had increased to $2,028.71. AMR’s per-mile rate in the county is $49.33; oxygen is $211; night calls have a $230.72 surcharge; and dry runs are $315.32, according to the Riverside County EMS Agency’s 2021-2022 ambulance rate sheet.

Rates charged by AMR for emergency transportation are regulated by the county and increase yearly based on changes to the consumer price index, according to Nicole Michel, director of public relations for Global Medical Response, AMR’s parent company. When asked if there was an average rate charged to users in the Coachella Valley, Michel wrote via email: “It is misleading to discuss the average charge for a particular area, as the amounts we receive for patient transports vary by payor. For example, the base reimbursement for an (emergency) ambulance transport for a patient on Medi-Cal, which represents more than 40 percent of our patients, is approximately $115. That rate has not increased at all since 1999. This reimbursement is far below our cost to provide the services.”

Michel pointed out that the pandemic had a negative impact on the industry, leading to staffing shortages across the U.S., including at AMR. Additionally, EMT and paramedic-training programs were put on hold during the pandemic.

“There are now fewer qualified EMTs and paramedics entering the industry because of those impacts,” Michel said.

Cathedral City provides its own fire and EMS services. The fire department’s base rate for both basic and advanced life-support services is $1,225, plus $28 per-mile, $60 for oxygen, a $119 surcharge for night calls, and $25 for miscellaneous supplies. The Cathedral City Fire Department provided 3,745 ambulance transports in 2021, according to the department’s annual report.

In 2016, The Desert Sun reported that the Cathedral City Fire Department had sued residents for thousands of dollars in unpaid ambulance bills. Then-Fire Chief Paul Wilson said the department operated the service at a loss: Each year between 2015 and 2018, the department reported total losses between $1.09 million to $1.5 million.

These lawsuits made an impression across the county. During a Palm Desert Public Safety Commission meeting the following year, the city’s administrative services director at the time, Lori Carney, said that one of the goals of the Emergency Medical Services Insurance Billing Program was to prevent the city from getting into the business of pursuing ambulance-service collections from residents.

Exactly who is covered by this benefit can be confusing, especially with all the visitors, guests snowbirds and second-home owners. According to De La Cruz, the patient needs to be considered a “resident.” The information is typically passed along based on the residential address given when the firefighters and paramedics arrive. This means that if you live in one of these three cities during the winter, but consider your other home your primary address, you need to give the paramedics your local address; it may make things easier down the line. Homeowners and long-term renters, of course, are covered.

Should other cities consider this model? The Cove Communities may be in a unique situation, because they’re wealthier cities where high-earners probably have pretty good health insurance, with many older residents who qualify for Medicare. The percentage of the population without health insurance and, thus, the amount that goes unpaid is likely lower than in other Coachella Valley cities.

But if there’s a way to affordably ensure that all residents have access to emergency medical care, each city should be working toward that.

Maria Sestito is an award-winning journalist and writer living in the Coachella Valley. Her work has appeared in publications across the country, including USA Today, and she previously covered health...