Unpaid EMS bills in SC can cause loss of tax refund

CHARLESTON, S.C. (WCSC) - A trip to the hospital in South Carolina can lead to patients eventually losing part of their tax refund, and right now, Lowcountry counties are looking to collect tens of millions of dollars in ambulance debt.

“They’re offered this life saving response to something terrible that’s happening to them and then they can actually have thousands of dollars of debt,” South Carolina Appleseed Legal Justice Center Director Sue Berkowitz said.

Every day, ambulances from county emergency medical services departments show up at Lowcountry hospitals, bringing people in need of medical care to a doctor right away. It’s a potentially life-saving service that can come as an out-of-pocket financial cost to patients, depending on their insurance situation.

In South Carolina, it is typically the responsibility of county EMS patients, not taxpayers, to pay for their ambulance ride, Berkowitz explained, adding that bills of hundreds to thousands of dollars can come as a shock to people.

If patients do not pay or cannot afford to pay for their ambulance ride after receiving a bill in the mail, some counties submit a list of debt that they are looking to collect to the South Carolina Association of Counties, a non-profit organization in Columbia that is allowed to serve as a middleman of sorts under the state’s Setoff Debt Collection Act.

The association then submits a list of all debt owed to their participating counties to the South Carolina Department of Revenue, which can withhold state income tax refunds from patients to pay for the original ambulance bills and a fee for the association’s service.

“Suddenly you find yourself in utter turmoil because you’re not getting that tax return back,” Berkowitz said. “For a lot of folks, when they get their tax return suddenly just yanked from them, it can cause other debt spiraling. Sometimes it is money that you thought you’d be able to pay off a loan or it’s money that you thought you’d be able to pay down other debts or maybe be able to get ahead on some of the other bills.”

A spokesperson for Charleston County, the largest county in the Lowcountry, said in an email that a total of $60,780,735 is currently owed to their EMS department. The amount covers an eight-year period.

“Charleston County EMS makes every attempt to contact and work with patients on payment plans as low as $5 [per] month,” Charleston County Public Information Officer Kelsey Barlow said. “EMS will not submit an account to debt set off provided a monthly amount is paid to keep the account active.”

In Colleton County, $15,483,989.22 is owed, according to Colleton County Fire-Rescue Chief Barry McRoy.

No one from Charleston County EMS, Colleton County Fire-Rescue, or the South Carolina Association of Counties would agree to an on-camera interview regarding ambulance debt collection.

Georgetown County Fire/EMS is owed $3,571,409.80 in ambulance debt while Dorchester County is looking to collect $3,740,000.

“Dorchester County EMS does use a collection agency for delinquent charges that we have been unsuccessful in collecting by any other means,” county spokesperson Craig Lloyd wrote in an email, “Additionally, Dorchester County EMS participates in the South Carolina Debt Setoff program where a part of any tax refunds would go to satisfying delinquent bills.”

Meanwhile, Berkeley and Williamsburg Counties are unsure how much they are looking to collect in ambulance debt.

A representative for Williamsburg County said that a third party company known as Lowcountry Billing handles all of their EMS debt collection. A Berkeley County spokesperson stated that the county is preparing to internalize its EMS billing and is not yet sure how many dollars they are owed.

It is not clear if any financial support services from non-profit organizations are available for ambulance patients without in-network insurance who are unable to pay their EMS bill. All Lowcountry charities that were contacted for this report stated that they do not offer assistance for county ambulance payments.

Berkowitz said that the best option that people who receive an EMS bill in the mail that they cannot pay have is to contact their county government and state lawmakers, adding that changes might be needed to the state’s ambulance funding process.

“I do think that we need to be looking at this as a policy issue and whether or not it’s time for our legislature to revisit it and whether it needs to be challenged.” Berkowitz said.

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