My 83 yo sister fell and hit her forehead requiring 50 stitches to close resulting injury. Her husband is unable to drive at night. Would Medicare have paid for the ambulance?
Medicare claims are paid by the Government; unless you have a Medicare Advantage Plan. The Government (CMS) follows the same guideline for everyone; that is medical necessity. Maybe your Ambulance service did not report your situation correctly.
Medicare pays a portion of the bill. Also, every time my mother has fell, I call 911 and tell them it’s not an emergency, but that my mother has fallen and I can’t get her up. The EMT’s always come and checks her out and we are never charged.
My mom had many falls over a period of three years. She also had seizures, mini strokes, and UTIs. Each and every time we went to the hospital, Medicare approved the ambulance ride. Only one time were we denied and the bill was about $1,000. I tried to appeal it but I lost. Apparently, I had waited too long.
About 18 months later my mom had lab work, ordered by her doctor. WE got charged over $1,000. This time I had a long conversation with Medicare. This individual was very helpful and told me that usually when patients are denied coverage by Medicare it's because someone coded the bill/invoice incorrectly. He told me that it was my mom's doctor's office who coded the lab invoice incorrectly. He told me to take it back to them and to ask them to redo it, that I had talked to Medicare who had advised that it was miscoded, and to resubmit it Medicare.
So, I then told the Medicare representative what had happened 18 months earlier with the ambulance bill. Again, he said that someone at the ambulance/paramedics office got lazy (his word) and coded it wrong. He said next time call them tell them we were denied and ask them to correct and resubmit the bill to Medicare. I hope this helps.
BlueEcho is correct - it's all about the billing. Check each medicare statement of what was paid and what was not. Call to find out why and start correction process, when needed, as quickly as possible.
Be sure to find out before you need an ambulance. Homeless here take an ambulance to ER to get cleaned up and a night's sleep....who pays for that? Where do they bill the homeless people. ?? Medicare and my insurance if it's medically necessary....meaning you can't ride in a car.. ...if you are admitted to hospital...you don't pay....if you are sent home you pay $300.
you know the answer..the taxpayer does. And if those who are willing to remove all 'laws of entry' to this country then the taxpayers will continue to pay for illegal aliens too (until the rule of law is removed then they are entering illegally, and are an alien to this nation, it's not 'slander' it is a fact. ) Oddly the people I see complain the most to permit globalism & open borders and medicare for all -cradle to grave- scream when they don't get medical care as fast or as often or as cheaply as they 'deserve'. I think they do not understand either the way ANY nation functions, or are ignorant of the Constitution. or both.
Make sure the ambulance carrier is coding the ride as emergency, otherwise you'll be paying the bill. My mother was transported from the rehab center to the ER when the rehab doctor told us blood work done at the rehab center was showing she had a blood clot. For whatever reason, the rehab center did not indicate to the ambulance carrier that this was an emergency, so it was coded "non-emergency" (unbeknownst to us) and we had to pay the cost even after several appeals.
I think you're safest bet is to call Medicare and ask. I have found in most cases with my clients the determining factor is if the service was "medically necessary". If it is medically necessary Medicare usually pays if not, they don't. From what others have posted it sounds like it can vary from state to state.
Yes, they always paid for my late mother's ambulance trips, but it's best to check your primary Medicare and your supplemental Medicare Plan Letter - if you in fact have Medicare Supp. Hitting one's head is deemed a medical emergency = ergo, the EMS.
There's a law on the books in Kentucky (unless they changed it) but as of 2015, when you use a public ambulance, they cannot charge you. The law states that any service entity (such as police, fire, ambulance) who takes tax-payer monies for their budget cannot also charge individuals. When I called to get the bill back to a zero balance the ambulance services would say they HAVE to bill or wouldn't be able to live off what the government gives them. When I addressed this with the County Attorney, the bills were reduced to a zero balance. If they bill you (illegally) and ruin your credit, you can sue for $40-50,000 for an unjustified ruined credit. The County Attorney knew this, too, and took care of the bill.
I've found that the times my 96 yr old mom who is in a assisted care has had to go to the ER for emergency care there has been no problem with them paying for it.
"Emergency care refers to emergency medical attention given to an individual who needs it. It includes those medical services required for the immediate diagnosis and treatment of medical conditions which, if not immediately diagnosed and treated, could lead to serious physical or mental disability or death."
IMO - "could lead to serious physical or mental disability or death." For any person other than a physician... I would suggest calling for an ambulance every time because you are not qualified to make a determination of someones medical condition or "need of care". Medicare should not refuse payment. They never have with my mother.
So, my answer to... "My 83 yo sister fell and hit her forehead requiring 50 stitches to close resulting injury. Her husband is unable to drive at night. Would Medicare have paid for the ambulance?"... is yes, they would have paid for it.
But, you need to be aware that getting your sister back to home (or to the assisted care in my mom's case) is on the patients shoulders. Even when they cannot walk or have other disabilities that prevent them from getting back on their own. That would be very difficult to get them to pay for.
Medicare pays for an ambulance to transport in an emergency. It depends on if there is additional insurance if there is and how much of a deductible. If advance life support is provided with the ambulance that charge is often separate and not covered.
If it is substance abuse, they will not pay. I had an elderly client who was going through DTs because he was drinking himself to death after his wife's death. The bill was $700 in 1997. They did not pay for ambulance but did pay on the hospital stay.
Around here if you call 911 and they come they attempt to bill whatever insurance you have to make $$ (for the city service of 911) but if I understand it correctly they don't hold you for the remainder if you don't have it...but I need to double check on that. They don't talk about it much for fear people will not call...
Another thing that needs checking into is if someone rides in ambulance with the person like a spouse what the fee is. My in laws 94 & 84 husband had to go to hospital & wife rode in ambulance it was an additional $ 800.00 just for her to ride along.
I fell late one summer evening (10 pm) while taking a 30 minute walk in a well-lit, safe area. Have no idea why I fell, as was just feet from going up the steps to my back door, as I was finishing up the 30 minutes. I’m now 70 and haven’t fallen since.
I was bleeding from my nose and possibly head - where I came down hard on a concrete walkway. No one nearby to help. I had my cellphone with me and not knowing whether I’d soon pass out, called 911. I’d been on Medicare for 3 months and knew an ambulance would be covered and my supplement plan F would pay the remainder. Medicare only pays for transport to closest hospital that can care for one’s particular injuries or needs - if you want a hospital further away that you personally prefer, they’ll not take you there if one closer can adequately treat you.
i ended up with a broken nose and elbow. Six months earlier I’d signed on with an inexpensive group accident insurance policy, thinking now that I was 65 I might well need it. They reimbursed me $4K for the surgery, ambulance, x-rays, ER, anesthesia, etc.
In short, know your benefits and complete the paperwork when necessary for reimbursement! In an emergency, Medicare pays for an ambulance. Supplemental Medicare policy should pay the rest, unless you’ve got a policy that has a deductible.
Agreed..being responsible for oneself or family is a PERSONAL responsibility.No one wants to pay for anything if they don't have to. but these are life events. I warned my friends who want to skip buying insurance that cover what Part B does not, they believe the medicare that covered 80% is enough, but that part B 20% can add up fast!! A $10,000 emergency of any kind is STILL $2000 out of pocket, and many don't read the Medicare guide that shows ONLY the hospital room is covered, AFTER deductible too. Part B is EVERYTHING else- bandages, the MD, X-rays, special treatments..ALL of it is part B. I took the Blue Shield plan F which is high deductible...I pay $55 month. do ~$670 a year. If I wanted a very low deductible I pay $200+ a month--so $2500 for CERTAIN each year, plus the deductible! If you are ill or believe you need many MD visits then choose what is best cost $$ for you.
There is NO reason a person can't pay for a cab ride home, or ask a friend or family member. The government is NOT supposed to pay for everything in our lives, and medical is part of that. A lazy 55 yr old man I knew let his mom call an ambulance to go to the hosp for an MRI..it was too much bother for him, the state pays the cost, which means all the taxpayers support his laziness. She also could have called a taxi, but did not, the cost is $20-$30 MAX to the hospital, so why is this such a burden?
Even if you save $10.to pay a neighbor of his gas/time in an emergency that is at least planing ahead, as we should.
Medicare will cover ambulance services, if they are medically necessary. If in doubt, make sure that the paramedic puts down a diagnosis that Medicare will pay for.
I would also check and see if their fire insurance, not sure what it is called, we don't live in the city so our house is covered by contract with rural fire and that includes medical transportation, however, they don't advertise the fact. We didn't know for 20 years that the 600.00 annually wasn't just for the fire department in case we had a fire.
It is worth checking into all of your insurance policies, homeowners etc to find out if they have any extras.
If at any time a person falls with head injury, DO NOT attempt to get them up. You need to rule out head or neck fracture with a CT scan which requires 911. You also have to rule out a brain bleed which may result from a fall that the head is impacted. You tell the 911 your loved one fell and her head is bleeding and afraid to get her up. I would imagine that would constitute a medical emergency. But I'm not a doctor or anything so what do I know, right?
"Ambulance services Medicare Part B (Medical Insurance) covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health. Medicare may pay for emergency ambulance transportation in an airplane or helicopter to a hospital if you need immediate and rapid ambulance transportation that ground transportation can’t provide." https://www.medicare.gov/coverage/ambulance-services
Please note my 89 year old mom with end-stage Alzheimer's had a bad UTI leaving her unable to walk, Medicare initially refused to pay it. I think it was the way the ambulance drivers charted it and never stated she was unable to stand or walk, and severely lethargic. I filed six months worth of appeals they finally approved it. I mean I must have sent at least 25 to 30 letters and appeals. Yes six months later they finally approved it. Wow. Even when the Emergency Room doctor wrote the diagnosis that her condition was a threat to her life -- WHICH IT WAS. Symptomatic UTI to the point she was unable to stand..
She had another episode of UTI and she got septic from that. Only through the Grace of God she survived that, and efficient medical care.
If at any time you have to fight for payment, please do so. DO NOT IGNORE ANY KIND OF DENIED CLAIM. Look at your Medicare statement VERY carefully.
If one can afford the cost, our town emergency squad has an annual fee you pay each January - $500.00. They will take you to and from the two local hospitals. For all others, the first two times in a year there is no charge. After that they send a bill for you to pay or submit to your insurance. Sometimes if it’s a discharge trip home, you may have to wait if there are emergency calls going on.
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About 18 months later my mom had lab work, ordered by her doctor. WE got charged over $1,000. This time I had a long conversation with Medicare. This individual was very helpful and told me that usually when patients are denied coverage by Medicare it's because someone coded the bill/invoice incorrectly. He told me that it was my mom's doctor's office who coded the lab invoice incorrectly. He told me to take it back to them and to ask them to redo it, that I had talked to Medicare who had advised that it was miscoded, and to resubmit it Medicare.
So, I then told the Medicare representative what had happened 18 months earlier with the ambulance bill. Again, he said that someone at the ambulance/paramedics office got lazy (his word) and coded it wrong. He said next time call them tell them we were denied and ask them to correct and resubmit the bill to Medicare. I hope this helps.
Where do they bill the homeless people. ??
Medicare and my insurance if it's medically necessary....meaning you can't ride in a car.. ...if you are admitted to hospital...you don't pay....if you are sent home you pay $300.
Medicare covers ambulance trips when the trips are medically necessary.
People reading these posts be careful because there are some misleading information here.
"Emergency care refers to emergency medical attention given to an individual who needs it. It includes those medical services required for the immediate diagnosis and treatment of medical conditions which, if not immediately diagnosed and treated, could lead to serious physical or mental disability or death."
IMO - "could lead to serious physical or mental disability or death." For any person other than a physician... I would suggest calling for an ambulance every time because you are not qualified to make a determination of someones medical condition or "need of care". Medicare should not refuse payment. They never have with my mother.
So, my answer to... "My 83 yo sister fell and hit her forehead requiring 50 stitches to close resulting injury. Her husband is unable to drive at night. Would Medicare have paid for the ambulance?"... is yes, they would have paid for it.
But, you need to be aware that getting your sister back to home (or to the assisted care in my mom's case) is on the patients shoulders. Even when they cannot walk or have other disabilities that prevent them from getting back on their own. That would be very difficult to get them to pay for.
I was bleeding from my nose and possibly head - where I came down hard on a concrete walkway. No one nearby to help. I had my cellphone with me and not knowing whether I’d soon pass out, called 911. I’d been on Medicare for 3 months and knew an ambulance would be covered and my supplement plan F would pay the remainder. Medicare only pays for transport to closest hospital that can care for one’s particular injuries or needs - if you want a hospital further away that you personally prefer, they’ll not take you there if one closer can adequately treat you.
i ended up with a broken nose and elbow. Six months earlier I’d signed on with an inexpensive group accident insurance policy, thinking now that I was 65 I might well need it. They reimbursed me $4K for the surgery, ambulance, x-rays, ER, anesthesia, etc.
In short, know your benefits and complete the paperwork when necessary for reimbursement! In an emergency, Medicare pays for an ambulance. Supplemental Medicare policy should pay the rest, unless you’ve got a policy that has a deductible.
There is NO reason a person can't pay for a cab ride home, or ask a friend or family member. The government is NOT supposed to pay for everything in our lives, and medical is part of that. A lazy 55 yr old man I knew let his mom call an ambulance to go to the hosp for an MRI..it was too much bother for him, the state pays the cost, which means all the taxpayers support his laziness. She also could have called a taxi, but did not, the cost is $20-$30 MAX to the hospital, so why is this such a burden?
Even if you save $10.to pay a neighbor of his gas/time in an emergency that is at least planing ahead, as we should.
It is worth checking into all of your insurance policies, homeowners etc to find out if they have any extras.
"Ambulance services
Medicare Part B (Medical Insurance) covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health. Medicare may pay for emergency ambulance transportation in an airplane or helicopter to a hospital if you need immediate and rapid ambulance transportation that ground transportation can’t provide."
https://www.medicare.gov/coverage/ambulance-services
Please note my 89 year old mom with end-stage Alzheimer's had a bad UTI leaving her unable to walk, Medicare initially refused to pay it. I think it was the way the ambulance drivers charted it and never stated she was unable to stand or walk, and severely lethargic. I filed six months worth of appeals they finally approved it. I mean I must have sent at least 25 to 30 letters and appeals. Yes six months later they finally approved it. Wow. Even when the Emergency Room doctor wrote the diagnosis that her condition was a threat to her life -- WHICH IT WAS. Symptomatic UTI to the point she was unable to stand..
She had another episode of UTI and she got septic from that. Only through the Grace of God she survived that, and efficient medical care.
If at any time you have to fight for payment, please do so. DO NOT IGNORE ANY KIND OF DENIED CLAIM. Look at your Medicare statement VERY carefully.