While taxes still provide a portion of operational funding, ambulance fees collected from insurance companies mitigate the taxpayer burden. Without billing for ambulance services, other Town funds would need to be redirected to support EMS. Additionally, more than 30% of patients using EMS in Guilderland live outside the town. If taxes were used as the only source of funding, non-Guilderland residents would essentially use the system for "free", while Guilderland residents paid the bill. EMS billing reduces the tax subsidy of EMS for Guilderland residents.
The Guilderland Town Board originally approved the EMS Billing Policy and Fee Scale in October 2019. In 2022, the fee scale was updated and approved by the Town Board. The rates were adjusted to include the fees for Ambulance Services, Vendor Requests, Education, and Training.