The Wauwatosa Fire Department, as one of a series of measures to balance its 2026 budget, is proposing to begin collecting up to $200 from local patients transported in one of its ambulances, a new policy known as "balance billing."
Patients who live outside Milwaukee County already are billed for the full cost of ambulance transports, but under Wauwatosa's current policy, the department declines to collect any payments directly from patients who live in Milwaukee County. Instead, the department seeks reimbursement from insurance companies and federal programs like Medicare and Medicaid, and then it writes off any uncollected remainder for those local residents.
That sometimes means a large portion of the bill for county residents goes unpaid. The cost to the city of an ambulance transport typically totals about $2,000, according to city officials, and insurance payments may not cover the entire amount.
Medicare and Medicaid reimbursement can be even lower for ambulance transport, though Medicare and Medicaid patients will be exempt from the $200 ambulance charge, because of federal restrictions on direct collections from those patients.
By collecting up to $200 from additional patients, the department hopes to increase revenue by $120,000. "Most of the fire departments in the area do this," Assistant Chief Barbara Kadrich said during the department's budget presentation Oct. 14 to the Wauwatosa Common Council's Finance Committee.
"We would prefer not to have to collect this $200" from local residents, Fire Chief Jim Case added, "but we've gotten to the point financially where we have to make some tough choices."
That revenue would help the department avoid additional cuts to its services. Under the proposed 2026 budget, the department already is preparing to eliminate one firefighter position through attrition, a change expected to to save $111,000.
Those and other proposed changes were highlighted in the presentation to the Finance Committee. Video of that meeting is available here, and the Fire Department's presentation begins at about 16 minutes. Discussion of the ambulance fee occurs at about 33 minutes.
The department's 2026 budget, totaling $17 million in expenses, starts on page 54 of the executive summary of the city's overall $81 million spending plan. Fire service has trended upward in recent years, with the number of calls for service increasing to 10,237 in 2024. More than half of those calls were for EMS response.
"Notably, we are managing this growing demand with the same number of apparatuses," the department says in its written budget summary.
Even so, the department has been able to maintain faster response times than the national standards of 90 seconds for daytime calls and two minutes for nighttime calls. Those times are defined as "the period between when a fire station receives notification of an emergency and when the first fire truck or ambulance responds."
Fire officials also emphasized that this budget does not reflect any of the predicted costs or savings related to a proposed merger with the West Allis Fire Department, which has not yet been approved but is in negotiations.
The Oct. 14 meeting also included presentations on the Health Department and Development Department budgets. The police budget will be discussed at the Oct. 21 meeting. A public hearing will occur on Oct. 28. Final passage of the budget by the full Common Council is scheduled for Nov. 18.
