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Learned a hard lesson
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GrammaBear Offline

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Post: #11
RE: Learned a hard lesson
(10-10-2015 11:36 PM)justMongo Wrote:  I got a bill for my July 17th EMT run. I was sweating whether Medicare would cover it -- they did. Just because you get a bill does not mean MC will not cover it.

(Side Note: When I read the title of this thread I was reminded of my hard learned lesson: Never marry a woman with adult kids at home -- they never leave!)

Unfortunately the bill I received states on the bill that it was submitted to Medicare and Medicare declined to pay it saying my condition didn't warrant it. Never mind the first hospital said my husband could not drive me because it wasn't hospital policy. I should have told them I would walk instead of ride the ambulance, I could have taken a taxi for lots cheaper than they are charging me.
10-11-2015 08:19 AM
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justMongo Offline

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Post: #12
RE: Learned a hard lesson
(10-11-2015 08:19 AM)GrammaBear Wrote:  
(10-10-2015 11:36 PM)justMongo Wrote:  I got a bill for my July 17th EMT run. I was sweating whether Medicare would cover it -- they did. Just because you get a bill does not mean MC will not cover it.

(Side Note: When I read the title of this thread I was reminded of my hard learned lesson: Never marry a woman with adult kids at home -- they never leave!)

Unfortunately the bill I received states on the bill that it was submitted to Medicare and Medicare declined to pay it saying my condition didn't warrant it. Never mind the first hospital said my husband could not drive me because it wasn't hospital policy. I should have told them I would walk instead of ride the ambulance, I could have taken a taxi for lots cheaper than they are charging me.

A couple of ways to go from here. Appeal it to MC. (I've not had much success with that.) Or, ask the billing entity to settle for the amount that MC would have paid.
If you go the latter -- write on the back of the check: In Full Accord and Satisfaction. If they cash it, then they cannot come back and ask for more because the legalese means that have settled the debt.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-11-2015 11:29 AM
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regbeach Offline

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Post: #13
RE: Learned a hard lesson
I agree with those who would not pay it until you make sure it was submitted correctly, talk to both the ambulance service and insurance. As others said, it could be a code issue (wrong one used). I would not go into detail about how you wanted to have your husband drive you. Bottom line, the dr. wanted to transfer you via ambulance so you went. My mom was transferred by an ambulance service from stroke rehab to sub-acute rehab because it was the facility's policy. We couldn't drive her. Medicare paid for it.
I would appeal it if talking doesn't work and include the documents from the hospital with your discharge info from the ER which likely states you were transferred via ambulance per the dr. If it doesn't state that, get the dr. to modify it for the appeal.
If your appeal is denied, then I would ask for a self-pay reduction from the ambulance service as someone stated. Medicare is hard to deal with but I found private companies are willing to work with you when insurance doesn't pay.
Good luck.
(This post was last modified: 10-11-2015 07:47 PM by regbeach.)
10-11-2015 07:38 PM
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Shastzi Offline

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Post: #14
RE: Learned a hard lesson
Sounds like misrepresentation.
The way is should go is: "We have to advise you that if you are transported for a non-life-threatening condition, you will need to use the ambulance and be charged accordingly. Otherwise sign this waiver form if you are ambulatory or have your own ride"

But..they would sometimes miss out on that juicy ambulance charge, right?

Smile

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(This post was last modified: 10-12-2015 03:26 PM by Shastzi.)
10-12-2015 07:50 AM
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Post: #15
RE: Learned a hard lesson
GrammaBear, I've never had to pay anything that Medicare disallowed. It is my understanding that all ambulance services must accept Medicare assignment and when they think your particular case may not be covered, they are supposed to inform you and have you sign an agreement to pay for the service in full with no Medicare billing involved.

I also understand that there is a form called ABN (Advanced Beneficiary Notification of Noncoverage) that must be signed by you if the service being provided is not covered by Medicare. If a 3rd party insists on ordering this service, they are required to notify you that it will not be covered by Medicare. Some 3rd party providers are ignorant of this rule. Did you sign an ABN form for this ambulance service?

If you didn't sign an ABN form, you certainly have a negotiable position. I would go at it with the intent of getting full relief from payment since you were not properly informed and had no opportunity to shop for an alternate service with lower rates. This smacks of a sweetheart deal between your medical care provider and the ambulance service.

Dude
10-12-2015 08:51 AM
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regbeach Offline

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Post: #16
RE: Learned a hard lesson
Like surferdude2, we have never paid for anything that Medicare disallows either. As he said, As long as you didn't sign the ABN indicating that if it is rejected by Medicare that you are responsible. I'm guessing the hospital thought it would be covered and didn't give you one to sign or you would have mentioned it. A provider has you sign the form when it is "probable or certain" that Medicare won't pay for some service. However, they don't have to provide an ABN if it is service that Medicare NEVER covers. I would say ambulance rides don't meet that criteria.
Do you have the Medicare handbook? Page 125- "If your provider was required to give you an ABN but didn't, in most cases your provider must pay you back what you paid for the item or service."
Page 42 details ambulance services- Medicare covers ground ambulance transportation when you need to be transported to a hospital........."for medically necessary services, and transportation in another vehicle could endanger your health." It goes on to say in some cases, "Medicare may pay for limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is necessary due to your medical condition."
(I take care of my mom....yes, I've actually read the Medicare handbook!)
10-12-2015 05:27 PM
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GrammaBear Offline

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Post: #17
RE: Learned a hard lesson
(10-12-2015 05:27 PM)regbeach Wrote:  Like surferdude2, we have never paid for anything that Medicare disallows either. As he said, As long as you didn't sign the ABN indicating that if it is rejected by Medicare that you are responsible. I'm guessing the hospital thought it would be covered and didn't give you one to sign or you would have mentioned it. A provider has you sign the form when it is "probable or certain" that Medicare won't pay for some service. However, they don't have to provide an ABN if it is service that Medicare NEVER covers. I would say ambulance rides don't meet that criteria.
Do you have the Medicare handbook? Page 125- "If your provider was required to give you an ABN but didn't, in most cases your provider must pay you back what you paid for the item or service."
Page 42 details ambulance services- Medicare covers ground ambulance transportation when you need to be transported to a hospital........."for medically necessary services, and transportation in another vehicle could endanger your health." It goes on to say in some cases, "Medicare may pay for limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is necessary due to your medical condition."
(I take care of my mom....yes, I've actually read the Medicare handbook!)

In regard to the ABN, I asked my husband if he signed anything that day I was in the local ER and he said 'No'. I was in such pain that if I signed anything I don't remember it, sure hope I did not. I feel bad enough about what happened to land me in the hospital in the first place without heaping more guilt on myself.

The following is the answer I received from my GP when I sent her a message via online patient portal regarding my problem with the ambulance bill:

I have printed the transfer form, you will need to sign a records consent. You might also want to talk to patient accounts about this.
10-12-2015 06:09 PM
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regbeach Offline

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Post: #18
RE: Learned a hard lesson
Hopefully, the transfer form shows the dr. required the ambulance. Hopefully, patient accounts will submit the dr. note to Medicare for you and get it all straightened out. But....It sounded like the ambulance service sent the bill not the GP so you maybe need to contact them directly and request that they submit the dr's notes to Medicare. If they won't, then you can via the Medicare appeal process. Good luck.
10-12-2015 10:44 PM
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Homerec130 Offline

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Post: #19
RE: Learned a hard lesson
A while back, I took my wife to urgent care for a face plant she did. Urgent care said because they could not do a CT scan, we would need to go the the ER (2 miles away). Because of her low blood pressure, I could not drive her so she needed to go by way of the red and white limo. Medicare and our supplement paid for all ambulance costs as well as both visits.

At the ER we found out there was nothing serious and they figured the face plant was due to her poor balance coupled with being on BP meds that she didn't really need.

So, it sounds like GrammaBear this may be a case of someone miscoding it. Oh, and if they go back in a recode it, make sure they use the codes that were in effect at the time. I know in the states we just changed over to a new coding system on Oct 1st. I went to get some bloodwork done and they refused it saying I had the old diagnosis codes on the form (even though they were correct when it was printed).

I just love paperwork.
10-13-2015 11:39 AM
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justMongo Offline

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Post: #20
RE: Learned a hard lesson
(10-13-2015 11:39 AM)Homerec130 Wrote:  ...just changed over to a new coding system on Oct 1st. I went to get some bloodwork done and they refused it saying I had the old diagnosis codes on the form (even though they were correct when it was printed).

I just love paperwork.

Oct 1st, Medicare switched to ICD-10 codes. Which means many bills will be coded incorrectly for months.

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
10-13-2015 01:38 PM
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