“I’ll never need an ambulance ride; why would I pay for a subscription I’ll never use?”

This might be the mindset of millions of Americans, but when catastrophe strikes, ambulance service can leave a person thousands of dollars in debt. The Pasadena, Calif., fire department, led by fire chief Chad Augustin, is one of many EMS services across the country that have implemented a subscription program to cover unforeseen yet necessary EMS services for residents who choose to participate.

In Pasadena’s case, Augustin said, $89 a year can bring peace of mind to residents by waiving whatever fees are not covered by insurance for an ambulance ride for subscribers. Though still in its infancy – the program rolled out on Jan. 1, 2023 — Augustin hopes to see continued growth in subsequent years. He called it a grassroots effort – “we’re really growing a program from the ground up” – and the fire department does not seek to make money off of it.

The welfare of the community he loves remains Augustin’s priority, as seen in his passion for the program. He sees it as a means of benefiting the citizens of Pasadena.

Previously, Augustin had lived in the state’s fast-paced capital, Sacramento. But he has been proud to call Pasadena home for the past two and a half years. He loves the city, home of the Tournament of Roses, with its “small-town feel.”

During his time in Sacramento, that city and various others in California had launched a similar subscription program. He wanted to bring the idea to his new home. Sacramento’s program began as a way to cover air ambulance services, which can cost anywhere from $15,000 to $25,000: seeing that, he questioned whether something could be put in place for ground ambulances because “for some people, it doesn’t matter if it’s a $1,000 bill or $10,000 if you don’t have the money, you don’t have the money. We were able to do that in Sacramento, so when I came down here and realized Pasadena didn’t have that program, it became an initiative we started working toward.”

Fire and lifesaving services are covered with Pasadena residents’ tax dollars, but ambulance rides are not. The subscription program covers ambulance rides only for private citizens, and the person being transported must live in the house that an ambulance is dispatched to and not be simply a guest.

The city of Pasadena provides its own “dual-role, duly trained firefighter-paramedics,” as Augustin explains it, and does not rely on an outside contractor. It’s able to work with the EMS biller to handle the subscription program in-house rather than through a third party, so membership is automatically noted on a bill. The city’s website gives additional information on the program, including FAQs.

Augustin’s team worked hard to get the word out to anyone who might need it, particularly the elderly or those with health issues. Social media posts, pamphlets mailed to utility customers, and being present at town hall meetings helped spread the word.

Overall, public reaction has been positive.

Public safety and wellness come first for the fire chief. He stated, “In general, most of us don’t think about our emergency plan until it hits us across the face – and now you have a multi-thousand-dollar hospital bill and an ambulance bill, and you aren’t working because you’re injured. So, part of this is education for our community.”

For residents whose insurance doesn’t cover EMS services, or who have a high deductible, it benefits them to add this additional piece. Participants who have no insurance at all see their bills reduced by half.

It took roughly a year of work to get the program going. Augustin noted that while it took time to organize, it required little expense.

The potential benefit, he continued, even if only a small percentage of people subscribe, is worth the effort. “It protects them from losing all their savings or possibly even worse – losing their home. Nobody wants that. It gives them that peace of mind, and the safety net is fantastic.”

In a difficult economy, that safety net is crucial.

“Most people are a couple paychecks away from not being able to pay rent or their mortgage. So, I think most of us, you budget for your regular expenses, but very few people have an emergency fund. If they have medical expenses from going to the emergency room, or they get an ambulance bill, they can’t just write a check for it. We definitely want to be aware of that and supportive of our community.”

There is still plenty of room for growth, he said, both in subscriptions and technology. The city of Pasadena plans to roll out a new website for the program so interested citizens can use a QR code or fillable subscription form to join.

Because Augustin wants to ensure that anyone can sign up, however, he intends to offer a low-tech option to those who would rather print and mail the form.

The subscription program is one piece of a larger puzzle, explained Augustin. Fire departments like his exhort citizens to have emergency plans for all kinds of disasters, and the ambulance subscription program is one aspect of that preparedness.

He stressed the importance of residents having an emergency plan in the event of an accident or illness when they might become incapacitated and unable to make medical and financial decisions.

“Just a little bit of awareness and education can go such a long way before somebody has a need,” Augustin said. “That’s what we’re trying to say to them: “Get yourself informed and educated and determine if it has value to you.”

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