When you call 9-1-1, you expect help to come quickly.
It generally does, but for some ambulance companies in Illinois, the cost of responding to some patients is adding up. The state is two point five billion dollars behind in its Medicaid bills.
Just about every ambulance company in the state feels the pinch. Getting paid six months late for transporting a patient who uses Medicaid, the state's health plan for the poor.
There's no quick fix in sight, and patients all over the state will see the costs of those late payments.
"Even some of the big players are feeling pinched and stretched," says Advanced Medical Transport CEO Andrew Rand.
He says the state is 190 days late on its Medicaid reimbursements to the ambulance company. Leaving it missing out on 600-thousand dollars, 20 percent of its total bills.
"Because of our size we are able to absorb some of the cash flow consequences I think," says Rand.
Genesis Illini Hospital says the state owes it three million dollars in late Medicaid bills. Rand says the late payments put pressure on non-essential ambulance rides. Like transports from small to large hospitals.
The state's backlog affects ambulance districts of all sizes, Geneseo is owed over three thousand dollars on nine calls since September, and some districts like Rock Island just expect that debt to never be paid.
"Right now we look at a 62 percent collection rate as to what we bill out, so it varies and it changes," says Rock Island Fire Chief Jim Fobert.
He builds bad debt into his budget. Saying it's easier to adjust expenses, than rely on money that may never get paid. He says the issue extends beyond ambulance services too.
"Right now I think what you're looking at is people waiting longer to go to the hospital, because they can't afford it, so when they do call it's more serious than if it was taken care of as a prior issue."
Fobert says his ambulances pick up a Medicare or Medicaid patient up to 75 percent of the time. City taxes help offset the bills not collected for ambulance services. Services Fobert says everyone dialing 9-1-1 will receive.
"We don't determine who we pick up, and the cost, we just go when we're told," says Fobert.
Whether they, or the state, can pay the bill.
Illinois offers businesses a chance to move their claims ahead in line based on their importance. The wait time on the expedited payment list can still last months.