In the Main Line parking lot, overdoses are common.

Soon-to-be patients of a relatively new facility, Recovery Centers of America at Devon, drive up or arrive on foot, ready to check themselves in for inpatient drug and alcohol addiction treatment. But some decide to use one last time, to say goodbye to a drug before they try to get clean and sober.

It’s yet another example of addiction’s grip on those battling the disease — and of the dire need for people to get help, said RCA at Devon’s leaders and Easttown Township officials.

But for the local volunteer fire company, every call for help from RCA is another one for which it might not get paid.

Last year, the Berwyn Fire Company responded to 102 total calls from RCA at Devon, billed $126,000, and collected only $40,000, he said.

“If something doesn’t change with how medical reimbursement works, we’re going to have a problem,” Berwyn Fire Chief Eamon Brazunas said, “sooner rather than later.”

RCA employees aren’t dialing 911 unnecessarily, Brazunas said. Employees call for parking-lot overdoses, dangerous levels of intoxication in patients seeking treatment, and for seizures and other serious side effects that can occur during alcohol detoxification, a potentially fatal process, said Caroline McWilliams, the facility’s medical director.

Brazunas attributes the nearly $86,000 in outstanding funds from last year not to RCA but to flaws in the way insurance companies handle medical billing reimbursement for out-of-network providers such as Berwyn Fire, which also provides EMS and advanced life support to Easttown and Tredyffrin residents. As RCA at Devon expands, calls there remain steady or increase, and the volunteer firefighter crisis continues, the problem could only worsen.

This predicament in Devon exemplifies a larger battle nationwide. A million-dollar lawsuit in federal court has criticized insurance companies for sending reimbursement checks to patients who sought addiction treatment rather than directly to providers.

In Easttown and Tredyffrin, given the number of calls from RCA and a growing number of senior living facilities in the area, the response time for residential fire and EMS calls could increase slightly, depending on the time and day of the week, Brazunas said.

Police have been affected, too, responding to RCA at Devon roughly every other day, said Easttown Police Chief David Obzud.

“We’re definitely there more than anywhere else in the township,” he said. But “more or less, that’s what comes with having this type of facility.”

In the shell of an old nursing home, RCA at Devon sits on a hill along busy Lancaster Avenue near car dealerships, office buildings, and a bowling alley. But, as even its executives have noticed in talking to Main Line residents over the last 18 months, many passersby are unaware of what happens there.

“People don’t know what goes on inside this facility,” said Steve Wicke, chief executive officer of RCA at Devon. He and his colleagues want more people to know. “We want people to understand addiction.”

Developer Brian O’Neill created Recovery Centers of America in 2016 at a time when addiction treatment was becoming a hot investment sector. A New York private-equity firm backed the development with $231.5 million in equity and debt. O’Neill invested $15 million.

His vision, he said, was to establish a chain of facilities from Boston to D.C. and save a million lives. At the time, he told The Inquirer that he planned to spend $20 million a year on advertising to reduce the stigma surrounding the disease. RCA’s number, 1-800-RECOVERY, was displayed on billboards and in commercials.

Today, RCA operates seven centers, including outpatient facilities in Trenton and Voorhees and its Lighthouse location in Mays Landing that offers inpatient and outpatient care (Mays Landing Fire Company could not be reached for comment about whether it has been affected). RCA planned to build a 317-bed facility in Blackwood, Camden County, but a fight ensued with residents of the town, stalling the project.

Recovery Centers purchased the 6.1 acres in Devon, previously Devon Manor, in 2016. RCA opened its doors there a year later and within hours, the first patient was admitted, Wicke said.

After several phases of expansion, the complex is now able to treat nearly 300 people. As of earlier this month, about 121 patients were undergoing inpatient treatment, an intensive 15-hour-a-day program in a setting that looks more like a hotel than a hospital.

In his experience, Wicke said, the comfortable rooms, nutritious food, nice gym, and other amenities help people stay in treatment longer, eliminating the excuses for why they can’t complete the program. So does being close to home and being able to have a patient’s family involved in recovery, he said.

The program is voluntary, and patients can choose to leave at any time. RCA accepts most major commercial insurance but not Medicaid. So for the insured, a stay can be relatively inexpensive — the price of a copay or deductible — compared with many well-known treatment centers across the country, Wicke said.

A spokesperson for RCA at Devon declined to put a dollar amount on the cost of treatment for the uninsured but said those with Medicaid are directed to other facilities.

RCA prides itself on being a “neighborhood place,” Wicke said, and as of January about 80 percent of patients came from within a 50-mile radius of the site.

The inpatient section consists of “neighborhoods” for men, women, young adults, and older adults, as well as for trauma victims and first responders. Clinical director Luke English said he was especially proud of that.

“We help the individuals in our community who help our community,” English said. “That’s a huge victory.”

RCA has also donated to the firefighters, police officers, and EMTs who find themselves at the facility so frequently, recently giving $25,000 to the Berwyn Fire Company and $15,000 to the Easttown Police Department.

Police responded to 150 calls to RCA at Devon last year, Chief Obzud said. Officers respond whenever an ambulance does, so many of those calls were medical-related. Other times, officers arrived for disturbances or to check on “walk-offs,” people who have signed themselves out of the facility and may be walking down Lancaster Avenue, he said.

Residential neighborhoods in the area haven’t been bothered, he said. In January, a Collingswood man robbed a bank after checking himself out of RCA, but incidents like that are rare, Obzud said.

Ultimately, he said, he would hesitate to say the uptick in calls has strained the police force, because officers are paid to respond.

For the fire company, it’s a different story.

“We don’t want to freak people out,” Brazunas said, “but they also need to know what’s going on.”

Brazunas takes issue with how insurance companies send reimbursement checks to patients for out-of-network service. The patients are supposed to send the check on to the provider, Berwyn Fire, but not everyone does. Making this issue even more concerning in this case, the people receiving the checks are trying to recover from addiction and could use that money for alcohol or drugs, he said.

“It’s astonishing,” Brazunas said. “If there’s anything more screwed up with health care, I don’t know what it is.”

This reimbursement process has put the fire company in a difficult position since RCA opened. They could track down a patient for not returning a check, Brazunas said, but they worry about whether that stress could prompt a relapse.

“Do you really want to take someone to court who’s going through addiction?” he said

Brazunas has been outspoken about his concerns, talking with legislators, local officials, and residents. Realistically, he said, he knows there’s a slim chance that anything will change with medical billing reimbursement anytime soon, barring “an earthquake in Harrisburg.”

The directors of RCA at Devon said they have started telling patients what to do when they receive reimbursement checks: Send them along to the Berwyn Fire Company. However, once the patient leaves, there’s little the center can do to ensure that that happens.

Without the full lot of medical billing reimbursement, Brazunas said, the fire company has to rely more on its other sources of funding: private donations and municipal support.

As of earlier this month, Berwyn Fire had responded to 22 calls from RCA at Devon since the beginning of the year. He said only 30 percent of the money billed for those calls had been collected.