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EMS Cost Recovery Program

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Beginning July 1, 2018, the Charlottesville Fire Department and the Charlottesville-Albemarle Rescue Squad will begin their emergency medical services (EMS) cost recovery program. Please see the below FAQ for more information. Albemarle County Fire and Rescue and every surrounding county currently utilize an EMS cost recovery program.

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Pay your ambulance transport bill



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Hardship waiver form



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Request a copy of your EMS patient care report




Frequently Asked Questions 

  1. General Questions

    Q: What is EMS Cost Recovery?

    A: EMS Cost Recovery is the process of obtaining financial reimbursement for the cost of providing medically necessary ambulance transportation. Medicaid, Medicare and most private and employer-sponsored health insurance policies provide for payment for ambulance transport. For more information on prehospital EMS services, see the National Highway Traffic Safety Administration's Office of EMS information document.

    Q: Why is the City of Charlottesville engaging in EMS Cost Recovery?

    A: Emergency medical calls account for a large percentage of the total number of emergency services calls in the City. For example, in 2016, there were over 5,000 EMS incidents in the City and 54% of Charlottesville Fire Department responses were for EMS incidents. As the need for emergency medical services continues to grow, the City, like many other localities, is seeking ways to fund these services without relying solely on local tax revenue or donations to local volunteer agencies.

    EMS Cost Recovery permits localities to recover system costs from those individuals who benefit directly from EMS delivery, including non-City residents, with the vast majority of the costs collected from Medicare, Medicaid and insurance companies.

    The EMS Cost Recovery program will be utilized to support the volunteers at the Charlottesville-Albemarle Rescue Squad (CARS), will provide a funding stream to support additional Charlottesville firefighters to staff ambulances in the City, and will support the acquisition and deployment of sophisticated EMS equipment.  

    Q: How will this program affect me?

    A: No one will ever be denied emergency service because of the EMS Cost Recovery Program. If a patient calls 911 but is not transported, there is no charge. City residents covered by Medicare, Medicaid, or private insurance will not be billed for any balances due after applicable insurance payments have been collected. City residents without insurance will not be billed at all. Non-City residents, in cases of hardship, may apply to the City for a hardship waiver once all applicable insurance payments have been collected.

    Q: Will the Charlottesville-Albemarle Rescue Squad (CARS) bill for service in the City?

    A: Yes. Both CARS and Charlottesville Fire Department staffed ambulances will bill for service as part of the EMS Cost Recovery Program.

    Q: How much money will be recovered?

    A: The City estimates that between $1M and $1.4M will be recovered annually. These funds will be used to support and strengthen the City’s combination volunteer-career EMS transport system.

    Q: What other localities in this area have EMS Cost Recovery programs?

    A: More than 40 cities, counties, and towns in Virginia currently bill for emergency ambulance transport to recover expenses and offset system costs. Localities in our region including Albemarle, Augusta, Greene, Fluvanna, Louisa, Nelson, Orange, Staunton and Rockingham bill for service, as do Richmond, Chesterfield, Hanover, Stafford, and Spotsylvania. Nearly 80% of Virginia residents live in localities that bill for EMS transport. Nationally, that percentage approaches 85%. Many other localities in Virginia are currently considering this type of EMS Cost Recovery.

  2. How Billing Works

    Q: How will the billing process work?

    A: The City of Charlottesville has contracted with a billing company, Digitech Computer, to handle the EMS billing process. Once patient information is collected, a claim form will be forwarded to the patient’s insurance provider, Medicare, or Medicaid.

    Q: What are the billing rates for this EMS service?

    A: Fees for ambulance transport range from $500 - $850 per transport, depending on the level of EMS care required by the patient. Rates are established by City Council. For more details, see the EMS fee schedule.

    Q: If an ambulance comes to my house but I don’t need transport, will I receive a bill?

    A: No. Fees are recovered only if a patient is transported.

    Q: If a fire engine comes to my house to provide EMS care, will I receive a bill?

    A: No. EMS first-response will remain a core service provided by the Charlottesville Fire Department. There is no fee for EMS first-response services. Fees are only recovered if a patient is transported in an ambulance to the hospital.

    Q: Who do I contact with questions about my bill?

    A: The City’s billing company, Digitech Computer, has customer service representatives to handle your billing and insurance questions at 888.447.9809.

  3. Ability to Pay

    What if I don’t have insurance and am unable to pay or have insurance but am unable to pay any balances due?

    The City of Charlottesville EMS Cost Recovery program includes compassionate billing provisions. If the patient is a City resident, he/she will not be responsible for any balance due once all applicable insurance payments have been collected. If the patient is not a City resident and cannot pay, he/she may request a hardship waiver form and will not have to pay. All patients will be treated and transported regardless of the ability to pay.

    If I have an outstanding balance on my insurance, will I be refused ambulance service?

    All patients will be treated and transported. This program will not change the ambulance service provided to anyone in the City of Charlottesville, regardless of insurance coverage or any other factor. The City of Charlottesville will not deny service to those with delinquent accounts. Billing does not occur until after service has taken place. Emergency responders who respond to a call will have no knowledge of who has paid and who has not paid.

  4. Insurance Information

    Will my health insurance premiums increase because of this billing?

    Unfortunately, health insurance premiums continue to rise regardless of whether or not a community decides to bill for EMS transports. Factors including the rise in prescription drug prices, the rising costs of hospitalization, an aging population, and litigation have resulted in escalating healthcare costs. Despite the steep increase in healthcare costs, ambulance transport costs represent less than 1% of health care expenditures. Many other local governments in Virginia have implemented similar EMS Cost Recovery programs, and they have reported no evidence that EMS billing increases health insurance premiums.

  5. Effects on the Volunteers

    How does this new program help the volunteers at the Charlottesville-Albemarle Rescue Squad (CARS)?

    The City is committed to utilizing a significant amount of this revenue source to provide operational funding to CARS. This funding stream will allow our dedicated volunteers to place greater focus on providing top-notch emergency medical care to our community and spend less time on administrative activities. EMS Cost Recovery Program funds will also help offset the rising costs associated with the provision of EMS services in the City.

    Will the rescue squad still need our donations?

    Yes. The cost of providing EMS services continues to rise and CARS will still need the public’s support. For more information and the ability to donate, please visit


For any further questions, please contact the Charlottesville EMS Billing Specialist:


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