Correct. The voluntary hospitals generally service the immediate area around them, but they can go pretty far depending on the agency. I mean I've been sent to entirely different boros while I'm working. You could call 911 in Manhattan and get a hospital unit from Queens or Brooklyn depending on what it is and where and what units are available.

Generally speaking though, the billing issue varies by agency. I know that Northwell ambulances do not bill unless you're transported. Pretty sure NYU and Presby are like that too. I guess Mount Sinai and others bill for RMA/AMA (refused medical attention). You can get around that by literally saying "no thanks I'm good" and walking away from them if you don't want help. Altho if you or someone else called an ambulance for you, chances are that there's something concerning and you should at least be evaluated if not transported. For me, I'd have to be unconscious to go by ambulance bc I'm stubborn.

EMS providers vary widely tho. I'll say that. Sometimes you get an excellent crew. Other times you're getting Dumb and Dumber. The EMS system in NYC and nationwide is hemorrhaging from the inside. We lost a LOT of great people before and during COVID, and it's hard to recruit good people now too. People don't wanna work in this profession anymore bc of the poor treatment and pay that we get. I don't regret my time in EMS tho.

You also get double billed for hospitals because FDNY bills for an NYC ambulance in addition to the actual hospital. I forgot how exactly the bill looks.

The billing varies by agency. Some places won't bill you at all unless you actually get transported to the hospital, and others will bill you just for being seen.