I just received a bill for my 89-year-old husband’s ambulance trip from his memory care facility to a local hospital. It was a staggering $3,700 for an eight-mile round trip. He has Alzheimer’s Disease and balance issues and fell in the presence of a witness who saw him on the floor holding his head. Now, mind you, potential head injuries are of special concern when seniors fall. So, usually, the first thing memory care personnel do is call an ambulance. Emergency medical technicians (EMTs) arrive, and they evaluate the patient for injuries. Then, they determine whether it’s “medically necessary” to transport him to a hospital. They did deem that it was, as they almost always do for the patient’s sake and to avoid legal liability. Fortunately, he wasn’t injured, except for minor bruising.
I assumed that Medicare would pay the bill as it always has, yet they rejected the ambulance service’s claim. Although Medicare is getting picky about claims for ambulance services, because of alleged abuse in emergency vehicle claims to Medicare, this was a legitimate claim.
The quandary this put my family in, is that my husband’s memory caregiving facility is required to contact emergency services when a resident falls. The catch-22 is that the only way to determine if the resident is injured, he must first be admitted by ambulance to the hospital emergency where doctors assess his condition. The ambulance company submitted its claim to Medicare, which rejected it, indicating that the ride, after all, wasn’t “medically necessary.” If Medicare rejects the claim, the person financially responsible for the patient is stuck with the bill, because gap insurance won’t cover it, either.
In most cases, these protocols adhered to by caregiving facilities, ambulances, and hospital emergency services, are “cover their asses” measures to avoid legal liability. As the trauma physician explained, this country’s healthcare system often requires its professionals to perform unnecessary medical tests and other extremes to avoid lawsuits. So much for our legal tort scheme.
About the only thing we can do is to call Medicare and get a precise explanation of what it will cover BEFORE we need to call EMTs. Medicare Coverage for Ambulance Services. It’s also smart to meet with the manager of the resident’s live-in care facility to try and arrive at a solution that doesn’t require a call for an ambulance. It might just be that a friend or loved one can safely transport the resident to the nearest hospital. Doubtful, but worth a try.
We want to hear from you, so feel free to share tips, ideas, and resources for seniors and caregivers with Grannybooster. Email me, Maris Somerville, at info@grannybooster.com
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