San Jose officials unanimously voted to approve a “First Responder Fee Program” that will charge $427 per emergency medical service trip made by the fire department to increase its funding — but who will foot the bill?
San José Spotlight dug deeper into the first responder fee program to address concerns from residents after Mayor Matt Mahan and councilmembers said they won’t be unduly burdened by the service fee.
The first responder fee goes into effect Jan. 1, 2026. Here’s what you need to know.
Who is on the hook for the $427 fee?
If the San Jose Fire Department uses emergency medical services to treat a resident, they will first get the resident’s insurance information so they can bill the insurance carrier.
“In cases where insurance information was collected on scene, the bill will be sent directly to the insurance provider — whether medical or auto depending on the response,” Tasha Dean, a spokesperson for Mahan’s office, told San José Spotlight. “If insurance was not collected on scene, the resident will later be given another opportunity to provide their insurance information.”
Dean said the fire department will not send anyone to collections for any portion of the fee that insurance does not cover. For example, if insurance covers 80% — $342 — the city will forgive the other 20% — $85.
The fire department plans to establish an agreement with a third-party company to bill and collect payments for first responder and vehicle collision response fees.
What happens if insurance doesn’t pay?
The fire department anticipates the fees to generate just more than $4 million per year based on the insurance pay rates, Fire Chief Robert Sapien told the City Council on Tuesday. There appear to be no plans in place to bill insured residents directly in the event insurance providers refuse to pay the fee.
“We will not send anyone to collections for any portion of the fee that insurance does not cover,” Dean said. “The bottom line is — the goal is not to burden residents with additional fees.”
What if I have Medi-Cal or Medicare?
Following the discussion on insurance pay rates, Councilmember Peter Ortiz asked fire department officials if they plan to pursue fee collections from residents with Medi-Cal or Medicare.
Sapien said the department will follow the model of fire agencies across California who have already implemented a first responder fee program.
“What we see in other agencies is that the person can advise … the city or the department of their circumstance and that they can’t pay — and then that’s it,” he said Tuesday. “Third-party billing firms that are familiar with (first responder fee programs) don’t pursue (those) collections. That’s what our intent is.”
What happens if I don’t have insurance?
If a resident receives EMS care from the fire department and doesn’t have medical insurance, the patient will be billed directly.
Would I have to pay the $427 fee if I don’t have insurance?
The city is developing a compassionate billing approach after reviewing the 23 fire agencies statewide already running first responder fee programs.
“If people are uninsured, they may pursue a reduction or waiver of their bill through our compassionate billing policy — the criteria for which is still being finalized,” Dean said.
Fire agencies have used three methods to provide financial relief for uninsured residents:
- Hardship waivers, which can reduce or eliminate fees based on income thresholds and specific hardship criteria.
- Flexible payment plans, which can extend the timeline residents have to to pay the fee.
- Full fee forgiveness, which is only granted for “extraordinary circumstances” such as natural disasters or severe medical emergencies.
District 2 Councilmember Pamela Campos said Tuesday she was concerned uninsured residents will be unaware or unable to access the compassionate billing options, and asked fire department officials to clarify how they’ll reach low-income communities.
“From the conversation we’ve had, it sounds like we’re really leaning toward helping neighbors and residents who don’t have the financial means to pay for this,” she said. “Is there a way we can address the (fee reductions) so that residents have more confidence?”
Sapien said the department will use an algorithm to determine which residents are eligible for compassionate billing and full fee waivers.
“It may not be appropriate to simply say we’re only going to bill some and not others,” he said. “In terms of making sure the community has awareness, we’re going to spend quite a few months trying to get the information out there before the program is ever even implemented. And then what we will use is an open platform … readily available online for individuals to work through their questions.”
Contact Vicente Vera at vicente@sanjosespotlight.com or follow @VicenteJVera on X.
This story originally appeared in San José Spotlight.
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