San Jose officials approve charging first responder fee

City leaders have approved a fee program allowing the San Jose Fire Department's emergency medical services to collect payments from people they treat.

Fire Chief Robert Sapien said San Jose needs to join the 23 fire agencies across California that already have first responder fees for people using the fire department's emergency medical services. While such services only represent about 16% of the fire department's total operating budget, demand for emergency medical care significantly increased after the COVID-19 pandemic -- with 911 incidents reaching all-time highs since 2022. Approved unanimously by the City Council Tuesday, the fire department will be able to bill $427 for emergency medical care starting Jan. 1, 2026.

Sapien said the city's fire department has evolved into a substantial medical care provider in the community since forming more than 170 years ago, responding to more 68,000 requests for emergency medical services in 2024.

"Implementing a first responder fee will align the department with other medical care providers, helping our community to sustain critical life safety services through cost recovery from medical care payers," he told San Jose Spotlight.

But residents who are treated by San Jose Fire Department first responders could be stuck footing the bill if they don't have insurance.

"It has become a common practice for fire agencies across California to fund the enhanced paramedic level of service through a user fee," Sapien said. "First responders will attempt to obtain medical insurance to collect the first responder fee. Similarly, most automobile insurance companies already have policies that include coverage for medical expenses."

Mayor Matt Mahan described the fee program as a community-centered approach that doesn't put an undue financial burden on residents.

"I really appreciate us being sensitive to the financial realities of our residents and focusing on what's billable and recoverable under insurance -- not going after residents," he said Tuesday. "This fee protects our response system in a way that is fair and sustainable."

The San Jose Fire Department only provided basic life support until 1995 when the department's Emergency Medical Services (EMS) evolved into providing more in-depth care as demand increased alongside the city's growth.

Medical-only EMS incidents have averaged 62% of total fire department response incidents over the past 10 years.

Fire department officials looked to neighboring agencies like the San Francisco Fire Department when calculating the $427 per-incident cost of San Jose's first responders fee. Cities with such programs target collections through commercial and private insurance companies with established billing policies to cover this fee type on behalf of the insured person.

The department has an 80% chance of collecting fee payments from residents with accident coverage or auto insurance, but only a 3% chance to collect from residents with private health insurance. This fee is distinct and cannot overlap with transport reimbursement, and it is solely for the cost incurred in assisting with EMS treatment of patients.

Sapien said the fire department expects to collect $4 million annually from the first responder fees.

"The first responder fee is the first step in a series of many that the city is looking to take to restore fire-based service in San Jose," Jerry May, spokesperson for San Jose Fire Fighters Local 230, told San Jose Spotlight. "It's encouraging to see solutions being proposed."

District 7 Councilmember Bien Doan, a former fire captain, said he wants underserved residents to know they won't be financially penalized under the fee program.

Uninsured residents can pay a reduced fee or get the fee waived altogether if they qualify for the "compassionate billing" provision.

"The final initial fee and associated annual revenue will be recommended as part of the 2025-26 proposed budget," Sapien said. "The department would establish an agreement with a third-party agency to perform billing and collection of revenue for the first responder and vehicle collision response fees."

Editor's note: This story was originally published by San Jose Spotlight.