PERHAM, Maine — The city of Caribou will no longer make ambulance runs to Perham unless the two municipalities sign a contract for services.
Caribou City Manager Dennis Marker said the state has been notified that as of Aug. 15 Caribou is no longer Perham’s primary EMS provider.
The 911 calls made by Perham residents will now go to Presque Isle, the nearest municipality with an ambulance service.
The city published a notice in the Aroostook Republican last month saying that Perham’s ambulance services would be terminated on Aug. 14. The town of Perham met with Caribou Mayor Mark Goughan shortly afterward to discuss the town’s concerns about the increased rates and the city’s method of billing the town.
Last year, Caribou City Council agreed to raise ambulance rates to outside communities from $11.50 per capita to $100 per capita, a nearly 1,000 percent increase. City officials said that the new rates would align with what Caribou taxpayers have been paying for the service, compensate for decreasing reimbursement rates and also help fund capital improvements needed for the city’s equipment.
The towns were given three options: $100 per capita for just EMS, $125 per capita for both fire and EMS, and a flat rate of $500 per call if personnel are available. The latter option, while less expensive, does not guarantee immediate response times.
Perham, and other surrounding towns, were critical of the sharp increase and initial two weeks notice given before contracts expired. The city then extended the deadline to March 31, and Goughan said during his July meeting with Perham that Caribou should have initially given communities more time.
Perham did not accept the $100 or $125 per capita options, citing that they were not able to organize a town meeting before March 31 amid the pandemic. Since then, the city has billed the town $2,500. Initially the town questioned why the bills did not include addresses or the nature of the calls. Caribou said that information could only be given to a HIPAA-certified representative in the town.
Once it was clarified that Perham has a HIPAA-certified representative, Caribou provided more information and Perham agreed to pay half of the balance on Aug. 10, four days before the termination deadline, as a show of good faith to continue negotiations over the billing process.
In a letter sent to the city on Aug. 11, Perham Town Administrator John Hedman said he appreciates the city’s efforts to help with additional information, adding that the town selectmen would like to see Caribou address three concerns before they commit to an agreement. The first is to set a limit on how much the town can pay annually, as Perham is only authorized to spend $10,000 on ambulance services for the fiscal year.
The second concern was that a mechanism should be set to catch and stop abuses with the billing system.
“With the current system,” Hedman wrote, “the town of Perham could have multiple no transport calls at $500 per call with no control or cap relative to service or billing. This is to say that Perham could have 10 calls at $500 per call or 100 calls at $500 per call.”
The town’s final concern was regarding Caribou’s decision to not bill private insurance companies, MaineCare or Medicare for ambulance transports.
“Our understanding, as stated multiple times to us,” Hedman wrote, “is that the City of Caribou has made the choice to not bill any other entity than the Town of Perham. We would like to integrate this standard practice (billing Medicare, etc.) into a final agreement.”
Hedman said the selectboard looks forward to continuing to work with the city to resolve these issues.
Marker said on Aug. 18 that Caribou will no longer provide ambulance services to Perham unless the city can obtain a contract with the town. He acknowledged receiving the partial payment from the town, adding the check “is not regarded as an extension of any contract terms or service guarantees because there are none without a contract.”
As of Aug. 19, Hedman said he has not received a response from the city addressing the three concerns outlined in his letter.
He said that while Perham is willing to pay an increased per capita rate for the service, it is not going to pay for such a steep increase.
“We’re not going to go from $11.50 to $100 per capita in one fell swoop,” he said. “Perham has had an annual contract with Caribou for at least 17 years and there has never been an issue from either party.”
Hedman said he checked with several communities from Houlton to Fort Kent, all of which charge roughly $11.50 to $16 per capita for ambulance services, and said he does not understand why Caribou is the only community that requires such a steep increase.
“We’re stubborn in Perham,” he said. “We may be small but if we think something isn’t right, we don’t give in. We don’t want to put our citizens at risk, but the feedback from the community is that they agree. A hundred bucks a head is ridiculous.”
