'Take me to the hospital" -- How Uber drivers feel when they get an ambulance run, 30 Days of Gotchas

This chart shows ambulance rides plummeting as Uber enters a market. (Click for study)

"Can you take me to the emergency room, I'm experiencing shortness of breath."

The passenger feared he might be having a heart attack. It might have been a false alarm. Either way, he wanted to get to the hospital fast. So, he summoned an Uber.

(This story is part of my 30 Days of Gotcha series, to mark publication of the new edition of my book Gotcha Capitalism, and its 10th anniversary.)

Rob, his Uber driver, will never know. But the Colorado-based Uber newbie has taken four different passengers (patients?) to the local hospital in recent weeks.

"One with a broken arm. One with a suspected broken collarbone. The last was a woman who didn’t tell me her problem but that she needed to go directly to the emergency room," Rob told me.

Uber drivers don't get much training to begin with; they are entirely unprepared for fares like that. Uber cars don't have equipment like the HeartStart OnSite AED package, so it can be hard for drivers to know what to do in a situation when performing CPR is involved. Saying this though, this is the reason why knowing basic first aid will come in handy. To begin immediate treatment during transport, drivers don't' even have to know CPR, though Rob -- a former volunteer EMT -- has been trained in the past.

Still, around the country, sick Americans are increasingly choosing to swipe an app rather than dial 911 when they fear a medical emergency. A recent University of Kansas study found that in cities where Uber becomes popular, ambulance rides fall by an average of 7 percent.

It sounds crazy, but which would you pick you pick: a $7 ride or a $900 ride?

One of the most popular Gotcha stories I've done since launching BobSullivan.net told the story of Jim Mathes, a Tennessee man who fell on his driveway and called an ambulance. Five miles and $800 later, he was really in pain. The piece solicited an avalanche of complaints from patients who felt like they'd been mistreated by ambulance providers who charge rates that work out to hundreds of dollars per mile -- huge fees that often aren't covered by insurance. My investigation of the situation revealed that ambulance services are often provided by for-profit companies based in far-away places -- one of the biggest is based in Sweden. Stories of $1,000, $2,000, and even $3,000 rides are easy to find.

Of course, it's not fair to compare taxi rates to ambulance rates. Sick people benefit from highly-trained technicians and vehicles outfitted with expensive equipment. Still, the industry is dominated by a small group of corporations that enjoy exclusive contracts -- a Gotcha staple. Plenty of other factors contribute to high costs, too. As with hospitals, there's a high write-off rate, meaning passengers who are able to pay often pay more than they should. And many ambulance calls aren't necessary, as the authors of the Kansas paper suggest. So siphoning off less-dire cases to a ride-sharing service might be good for everyone involved.

"Our results represent at least a 7% decrease in the ambulance rate from Uber entry into a city. This decrease likely caused a reduction in wait time for the remaining ambulance volume," the authors write.

Those are just cold statistics, however. A patient experiencing chest pains often has no way of knowing whether she is having a heart attack or indigestion. Neither does the Uber driver, who certainly isn't earning a premium for high-stress ride to the ER.

"As for my feelings about taking people to the hospital who are in need of emergency care, I certainly felt concerned with the gentleman who believed he was having a heart attack. Having been an EMT on a rescue squad as a younger man, I was well aware of the danger he might have been facing. I asked him if he wanted an ambulance and he said no," Rob said. "I told him if he felt worse during the drive to immediately let me know. I escorted him into the ER until I was sure he was safely with hospital personnel. I was also concerned about the woman who didn't offer up her problem even when I probed in a roundabout way to determine what her medical emergency might be that morning."

Rob knows that patients are making a simple business decision when they summon him instead of an ambulance to go to the hospital. A GAO study in 2012 found the median ambulance cost per transport for ambulance providers ranges from $224 to $2,204.

"I am well aware of the costs people face if they request an ambulance and I do think that plays a role in their determination to seek an alternative way of getting to the hospital," he said. "In the case of the individual with a possible cardiac problem, the minutes he spent waiting for me to pick him up would have been much better spent in the care of our local paramedics while on-board an ambulance that would have reached him much faster than I did..."When I was on a rescue squad years ago, there was no cost to anyone who summoned our assistance via 911. It’s a damn shame that that isn’t the case today in many communities across the country."

Whether you connect to a volunteer or a for-profit ambulance -- let alone an in-network or out-of-network ambulance not covered by insurance -- when dialing 911 is pretty much luck of the draw. That's part of the reason that costs can range from nearly free to thousands of dollars. As just one example, in Wisconsin, 75% of the emergency staff in the state's 425 services are volunteers, but they respond to only about 25% of the calls. Volunteer responses aren't free, either; someone has to pay for the vehicle.

As for Rob, he takes his faux ambulance driver responsibilities seriously. Occasionally, his passengers appreciate it. That potential cardiac did.

"He tipped me through the app. So, either I got his last dollar spent on earth or he's OK," Rob said.

RED TAPE WRESTLING TIPS

The middle of a health crisis is no time to find out about the wide disparity in ambulance costs. It's worth checking your insurance now to see which ambulance rides are covered where you live and where your loved ones live, particularly elderly or sick family members. It's also worth doing some back-of-the-envelope calculations about what would be faster in a crisis -- 911 or a ride-sharing service. When non-life-threatening injuries are involved, such as simple fractures, Uber can be a sensible alternative. In fact, some cities (even Washington D.C.!) are considering integration of ride sharing into their ambulance plans.

Still, if there's any doubt about the severity of a health crisis, call 911 and figure out the math later.

Know that many consumers are able to negotiate with transport firms and get a break on the bill, particularly if they promise to pay upfront. Consumers can also appeal a non-payment by their insurance companies. Most insurance doesn’t pay for ambulance rides that are considered a non-emergency, so the way the transport firm codes the bill is critical. Ask the ambulance provider to resubmit a bill coded as an emergency, if that’s appropriate.

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