This Bay Area city just passed a $427 'first responder fee'

SAN JOSE, Calif. - San Jose will join other Bay Area cities in billing insurance companies when its fire department provides medical care.

The San Jose Fire Department said that about two-thirds of its calls involve medical care, whether responding to a home or a vehicle accident.

This week, the City Council unanimously approved a plan to help recover some of those medical costs.

First responder fee

What's next:

San Jose Mayor Matt Mahan said, "What we are looking at is a trend line that is very concerning. Our fire department is responding to more and more medical calls where they are performing health care services, medical services, out in the field."

The council approved a plan for the fire department to charge a "first responder fee," which would apply only in cases where medical care is given similar to what might be received in a clinic or hospital.

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"All we are saying is for the sustainability of our department we need to be able to bill insurance when it is available to collect — or recover the cost—of providing medical care out in the field," Mahan said.

Several Bay Area cities have similar fees

Dig deeper:

California law has allowed such fees since the 1990s, and more than 20 cities currently use them. Around the Bay Area, several cities have a range of fees: $561 in Vallejo, $393 in Alameda, and $338 in Napa, according to a report the fire department provided to the council.

In San Francisco, their fee is $567, but the fire department contacted us to offer this clarification: 

"The SFFD does not charge a first responder fee. The ‘Treatment-No Transport’ is not a first responder fee," SF Deputy Fire Chief Mark Corso said. "We charge if our first responder units provide medical services to the patient, and they do not end up being transported. This is waived for very minor care provided; however, when we are providing medical care, conducting assessments, etc., we bill for these services."

San Jose’s new fee will be $427, effective Jan. 1, 2026.

Before the fees were approved, some council members expressed concern that people might hesitate to call 911 if there could be a fee later.

San Jose Fire Chief Robert Sapien said that issue was carefully researched in discussions with cities that currently have the fees.

"None reported a detrimental effect to 911 access. We didn’t hear anyone say that we implemented this program and then people became fearful or leery of calling," Sapien said.

Resident Elijah Gardere was not so sure.

"Definitely some might have some hesitation based on their insurance or if they even have insurance," he said.

Gardere added he supported the fees if they would help build or stabilize fire department services.

Bill sent to insurance companies, not policyholders

What's next:

The mayor was clear though, that these fees would only be billed to insurance carriers and not to individuals.

"If it is not recoverable, we are not going after folks. We are not sending debt collectors, it is not going to ding your credit, we are not interested in collecting directly from residents," Mahan said. 

It is estimated this first responder fee could generate about $4 million each year, which the city says will help the fire department continue to provide services.