The Medical Rescue Team South Authority, which used to tout the fact that none of its member communities had to pay for its services, reversed that practice in 2003 by billing its member towns for previous years' deficits.

But this year, for the first time, the South Hills ambulance company is billing its six member communities a total of $414,000 in projected 2006 deficits in order to be able to have enough cash on hand to pay its bills, including payroll.

Several communities have questions about the practice and the authority's budget and it remains to be seen if the towns will pay the bills.

"Frankly, I just have a real problem with asking for a payment for something that is still an unknown," said Russell McKibben, Dormont's police chief and interim manager.

He said Dormont council had numerous questions and hadn't made a decision on whether it would pay its assessment, which is $53,371.

Mt. Lebanon, which owes the largest share at $189,075, has instructed municipal Manager Stephen Feller to send a letter to MRTSA questioning the assessment and asking if the authority had made all the trims it could to reduce waste.

"I think that we will be cautiously examining their request," said Green Tree Manager Dave Montz. He said Green Tree's bill, $26,892, was a shock and it had to be questioned. "We were never told about it until the last minute."

Whitehall Manager James Leventry and Castle Shannon Mayor Donald Baumgarten said their towns would probably pay the bills, but Castle Shannon officials have questions. Officials from Baldwin Township could not be reached for comment.

Meeting today

Managers from the member towns are to meet this afternoon to discuss their concerns about the issue.

MRTSA serves Baldwin Township, Castle Shannon, Dormont, Green Tree, Mt. Lebanon and Whitehall and takes about 10,000 calls a day.

Baldwin Township was billed $12,826, Castle Shannon was billed $48,820 and Whitehall was billed $82,746. The amounts are based on a formula which takes into account each town's population from the 2000 census.

Those figures do not include $175,573 in assessments for 2004, the last year audited. Those bills also went out in December and are due immediately.

In years past, the entire budget was paid through insurance reimbursements and $40 household memberships, MRTSA board President Robert J. McKown said. Although the membership fee has been increased to $50, memberships dropped from about 12,000 three or four years ago to 9,000 in 2005, said Mr. McKown, who is a Whitehall councilman and a certified public accountant.

The memberships dropped, in part, because people figured their insurance would pay for transport. But at the same time, insurance reimbursements decreased and federal plans, such as Medicare and Medicaid, paid on delayed schedules, sometimes as much as 240 days after being billed, Mr. McKown said.

Decreased reimbursements are a huge problem, Mr. McKown said, because it costs an average of $700 to send an ambulance out on a call. Sometimes, insurance companies pay $280 to $350 per trip, he said. Other times, the ambulance reports to a scene, treats someone but that person declines transport. In those instances, the company cannot bill anyone.

Costs go up

Such practices put the authority in a cash flow crunch, he said.

At the same time, the service's costs have gone up, including health insurance and workers' compensation fees for its staff.

Other adjustments include the elimination of the wheelchair transport program, which took people in wheelchairs to medical appointments. The program didn't pay for itself. The service also lost some medical transport revenue when St. Clair Hospital opened its own cancer treatment center and patients no longer needed rides to Oakland and elsewhere.

But other expenses increased, including $96,000 more in pay and benefits to add two paramedics to the corps during the hours of 2 and 10 p.m., when calls are the heaviest, Mr. McKown said. Previously, the service had four crews on during the day, three in the evening and two overnight. But they found during the day response times were increasing because all of MRTSA's teams were out and even neighboring communities were too busy to respond quickly.

Standards high

While the state requires a response time of 10 minutes, MRTSA's standard has been less than five minutes, Mr. McKown said, and the authority wanted to keep it that way.

Lawrence A. Franck, MRTSA's executive director, said some of those response times were getting up to 6¹/₂ minutes.

Bills sent to the municipalities say that after 2006's finances are reconciled, communities may receive adjustments if they paid too much or too little.

Communities have not been billed for 2005's deficit, but once that year is squared away, Mr. McKown said, he hopes communities will adjust to paying ahead.

"We're trying to be the best we can," said Mayor Baumgarten, who has been on the MRTSA board since the 1970s. "The money is not there to support it 100 percent through third-party billing. ... Communities will have to realize if they want this service, they'll have to pay for it."

Still, he is concerned because the deficit includes about $250,000 for depreciation, which some communities think shouldn't have to be paid for in cash. But Mr. McKown said the authority had to have that cash because its main equipment is ambulances and, while they do depreciate, they also have to be replaced every three to four years. If the cash isn't on hand, it creates a problem.

Mr. McKown said the authority was operating as close to the bone as it could. But the changing operations of health care might require that communities put tax dollars toward the ambulance.

The ambulance company's operating budget this year is about $3.3 million. It employs 12 administrative employees, 34 paramedics and emergency medical technicians and has seven vehicles, Mr. Franck said.