An expensive ride

Given the large retirement population, medical emergencies are a regular occurrence in the Mountain Area, and with facilities quite a distance, Sierra Ambulance plays a key role in saving lives. However, ambulance transport can come with a surprisingly hefty price tag.

“Yes, ambulance service is expensive,” General Manager Ed Guzman explained, “but it mimics the cost of health care in general, and there are several reasons why things cost so much.”

Guzman said having paramedics and ambulances on stand-by to respond to 9-1-1 calls is costly, since the personnel are paid whether there are calls or not.

“Our rates reflect the cost of that readiness,” Guzman said. “Unfortunately, we do not receive any government subsidy so our services are financed through patient billings, plus whatever fundraising we can do. As a non-profit, we only charge what it costs to provide service to the community.”

Sierra Ambulance, which staffs three paramedic ambulances 24/7 at three locations (Bass Lake, Oakhurst, and Coarsegold) provides service regardless of ability to pay or the kind of insurance the patient does or does not have. They average about 10 calls daily, and transport about 2,800 of the 3,500 annual calls.

“We have a yearly budget of an estimated $2.5 million, and we divide that money among the number of calls we anticipate running, based on past experience, and among the types of insurance that those people will likely have.”

There are specific guidelines when billing government insurance programs such as Medicare and MediCal, which advise what they will pay - and not a cent more. Sierra Ambulance is prohibited from billing the patient for any balance beyond that amount.

“It has been 10 years since our last Medicare rate increase and 14 years since our last MediCal rate increase. Add to these steep discounts that we are required to accept on patients who have no insurance, and pay nothing, and we are left with a huge imbalance,” Guzman added. “It costs us about $800 per transport to meet our budget. We make up the difference by shifting the remaining cost on to the private insurance sector. This cost shifting is a common practice. Hospitals do it. Physicians do it. It’s how we all stay in business.”

According to Guzman, because this is a rural area with the population spread out across Eastern Madera County, the cost is higher than in Fresno, where a call can last 45 minutes and an ambulance crew can easily run 10 or more calls in a 24-hour period. Compare that to Mountain Area crews, where a call lasts three hours, and only three or four runs can be made in the same 24 period, resulting in a higher cost per call.

“Our rates are high, but they are what they need to be to provide an acceptable level of service to the community, and to provide liveable wages and benefits to my paramedics,” Guzman said. “No one is getting rich at Sierra Ambulance. I’m actually very proud of what we accomplish with the resources at our disposal.”

Family membership

As a non-profit corporation, Sierra Ambulance relies on the Family Membership Program, where for $65 dollars yearly per household, a family can purchase an ambulance membership. It covers the cost of ambulance transport from within Sierra’s service area to any area hospital in Madera, Fresno or Mariposa county.

These membership fees not only provide a benefit to those covered, but also help raise money to purchase new ambulances and equipment, which runs into tens of thousands of dollars. Ambulances top out at 300,000 miles (about six years).

To purchase a new chassis runs $80,000, while a new ambulance is $130,000. One main piece of medical equipment - a multi-functioning device which monitors all vital signs - is $30,000.

“Many don’t think of a membership as a gift, but if you aren’t sure what to purchase a loved one for Christmas,” Guzman said, “these year-long memberships make a thoughtful and useful gift.”

To purchase a family membership, (559) 642-0650, or visit