Who covers an ER visit if a patient was on hospice?

J, we have loads of technology, but when you agree to hospice care, you are saying " I'm willing to forgo the techno for comfort, because I know what I have can't be cured, even with most advanced techniques.".


In my mind, the EMTs should have assisted with getting the person into the house and allowed comfort measures to be taken.

Whatever bills arise are bills of dads, & as dad has died they become debts of dads estate. Not your or your brothers. In all likelihood there will be all sorts of bills coming in...... so start a file, binder on this & other post death items. If the revocation of Hospice doesn’t work then...

Here’s my suggestion as to what to do when bills come in:
do a short maybe 2 paragraph letter that states.....”In regard to invoice #1234 dated 56788 for Joseph Robert Smith, Jr, Mr Smith died on 3456 & as such all outstanding debts will be considered debts of his estate & subject to the probate laws of the State of bnm.

Paragraph 2: Probate is anticipated to be opened within the next year / near future. Any further correspondence or billing should be directed once probate opened & as per information in the Notice to Creditors posted as per probate requirements. Thank you for your attention to this.” You sign it as Family of Joseph Smith, not your name.
You send out this letter to each creditor 

You send the first ones out via certified mail with the return receipt postcard. Like $8.00 from USPO. The 2nd, 3rd letters can go out regular mail but write down dates.

I’d try to find out what the exact timeframe is required for probate to be opened is for your state (like TX is 4 years from date of death), so IF you should get a call on your cell or home phone you firmly state the probate to be opened by timeframe and they (debt collectors) cannot contact you as it’s not your debt. Meanwhile you can try to nudge Medicare to reinstate dad retroactively...... good luck on that!

I think you need to send the "revokation of hospice" paperwork to Medicare. First, talk to the Medicare folks via phone and find out if they have that. If not, supply it to them. If you don't have a copy, get it from the hospice provider.

I believe the fact that one has to go through this is evidence of failure of the American healthcare system. We may have some of the best technological methods of treating illnesses and saving lives, but the bureaucracy sometimes it inaccessible when needed. One almost needs a lawyer by his/her side to figure out what and what not to sign in an emergency.

Pj guy,
OK, you said your father "collapsed" in the driveway. One could infer that he was still alive, just fainted or fell.
But then you said, the fire department tried to "resuscitate" him, meaning he was unresponsive and dying.
Hospice nurse came and said no transporting unless you (in essence) cancel hospice by signing paper. I'm assuming your father was clinically dying or was presumed dead at this point.

As I understand it from the hospice company I work for;
A patient may be transported to the hospital (and continue to be enrolled with hospice) for a COMFORT procedure only. (Think casting a broken leg.) That helps the patients pain but does NOT attempt to treat the underlying condition that the patient is dying from.

Yours is a sticky situation. If your dad just fell and broke something, he could be transported to the hospital for COMFORT CARE. In this situation, he would still be under hospice.
SINCE your dad was unresponsive and possibly had no vital signs, that would have meant the end of his life. By taking him to the hospital (to attempt to revive him), that is against hospice's policies to let the patient die naturally without receiving life sustaining actions or treatment.

Since you wanted him to be taken to the hospital, because he was unresponsive, hospice HAS to discharge him BECAUSE he will receive attempted life saving treatment.

So technicality-yes, he WAS on hospice UNTIL you signed the discharge paper. THEN he was on straight MEDICARE. If you're gonna' split hairs, Medicare would be responsible to pay because he had been discharged from hospice and was no longer receiving hospice care when the firemen/paramedics put him in the ambulance.

Sorry to say, this tiny technicality could hold up payment for years!
Just don't pay it. Let them sort it out among themselves.
This is medical red tape.
I'm so sorry for your loss and your situation.

This is interesting because Hospice typically bills Medicare and they get payed through Medicare. So either way Medicare pays the bill.
Did your Dad have any other insurance? If so you should have them submit the bill through that insurance.
This may come down to the exact time of the revocation of Hospice and what was done after that. Typically Hospice will not cover any hospital procedure so anything done in the hospital would not be covered by Hospice.

My husband entered hospice last September 2016. We were told that Medicare would pay for any treatments unrelated to his hospice diagnosis (Non Hodgkin's Lymphoma). Hospice would pay for palliative care related to his cancer. We had a problem paying for Epogen which is an expensive drug which treats anemia. His cancer caused anemia. At first both Medicare and Hospice refused to pay for this medication. Eventually, we got hospice to say that Epogen was unrelated to treating his cancer. Then we could afford to pay for this drug (which costs $4000/month without insurance). When my husband got pneumonia, Medicare paid for his ambulance and hospitalization--since pneumonia is unrelated to cancer (except probably severe anemia lowers the immune system). Hospice covers palliative care related to the hospice diagnosis. Sometimes administrative staff will say you have to revoke hospice to be treated in the ER. But this is not necessarily so. Also once you revoke hospice and come back from the ER, you can then enter hospice again.

Hospice typically means no heroic measures so I am wondering why the son revoked it? Since he did, I would think he will have to prove to MCR hospice was not in place at time of transport.

A DNR should have been in place and available to the EMS personal. I agree that the EMS should have helped Dad back into the house and let the hospice nurse evaluate the situation. But...that is water under the bridge. As said, get the paperwork your brother signed. Call Medicare, explain the situation and ask where the paperwork should be sent. If you have adecline from Medicare there is a paper where you can appeal it. Do not do nothing. Hospitals are good at inflating costs. They have to except what Medicare pays.

hi. I also had hospice for my parents. I signed a form stating that hospice was the only care giver for my parents, I was explained on several occasions that if I called 911 or an ambulance to take them to the hospital I would have to pay the entire bill.
how it was explained to me was that hospice was there to make my parents as comfortable as they could, pain free if possible to the end. and if someone decided to call someone else for help than the contract we had was no longer in force and I would be responsible for entire bill. I would say maybe you should try and explain to hospice that took care of your dad that your family member was not aware of the hospice rules and regulations and that is why he called for help. maybe you will be lucky to get someone to help you. another idea is to go to the hospital and speak with the Social Services people and explain the situation. good luck ....