Fresno County is saving millions of taxpayer dollars by not picking up some people who call for an ambulance.
Those callers aren't being neglected. They've simply been identified as "regulars" who abuse the ambulance system.
Emergency calls come fast and furious at American Ambulance. Dispatchers and paramedics are quick to respond to trouble.
But sometimes the people they see and the voices they hear are a little too familiar.
"Most people don't need ambulances routinely, so even 10 or 12 is a lot, but 25 will get my attention especially within a tight span of time," said Ken Katz of American Ambulance.
Frequent flyers can clog the system - calling 911 for an ambulance ride they don't need to a hospital that can't help them.
Dan Lynch, A Fresno County EMS coordinator, said every day, there are people who use it to get to the other side of town.
Lynch decided the problem was too big to ignore in 2011 when two men combined for more than 1,300 ambulance rides.
For nearly seven years now, the county has built a "no-fly" list for ambulance abusers -- people calling at least twice a month for three months.
So far, 16 people have gotten through three warnings, kept calling, and made the list - meaning paramedics are allowed to deny them a ride if they don't seem to have a real emergency.
Dale Whitley called 911 almost 100 times in nine months last year before he got banned in September.
"Mental reasons and medical reasons. Those are the only two reasons," Whitley said.
Whitley said he feels like he's only requesting an ambulance when he really needs it, but he often has allergic reactions and suicidal depression.
An ambulance ride and a basic hospital visit cost about $800, so taxpayers covered somewhere around $80,000 worth of care for Whitley before his ban.
But he says he's afraid for his life and needs help.
Lynch says he's just looking in the wrong place.
Fresno County's program tries to divert ambulance abusers into programs for mental health and social services.
"We want to get them help. We've always said we want to help them out of the system before we have to shut them out of the system," Lynch said.
Cities like Minneapolis are using Fresno County's program as a model for their own.
Paramedics say it lets them focus on their mission - saving lives in true emergencies.
Fresno County creates ambulance 'no-fly list' to save millions of dollars