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Today I get a call from the nurse (not even an administrator!) telling me they will no longer transport him to his doctor because it costs the facility $700 each time. Doesn't Medicaid pay this? Anyone else have this issue? Anyone know anything they can share or point me in the direction of who to talk to?
Thanks!

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I have never heard of a NH paying for transportation out of their own pocket. Does the NH have their own transport? If not, I would find out what transportation service they use and call them. Find out from them who they bill the service too. Medicare, Medicaid or the Nursing Home. If Medicare or Medicaid ask if there is any reason why now they would not pay. If they bill the NH, call the billing office and see how they handle the billing. Then ask them, why the nurse told you its no longer covered. I have always had the impression that the company supplying the service bills Medicare and Medicaid.

Did Dad just go on Medicaid? If the NH has their own transport, maybe it was covered under Private pay. Now he is on Medicaid they can't bill them. Medicare usually doesn't pay for non-emergency transport.

My daughter is an RN working 20 years in rehabs/nh facilities. Recently, I found she knows the difference between Medicare and Medicaid (which at her age a lot of people don't) but she really doesn't know how they work, what they do and don't do. So like any business, don't expect a Nurse to know how the billing department works. Actually like you, I would wonder why an RN is calling you and not the billing dept.

I too would question why Dad needs to see to continue to see a urologist. My DH has been going every 6 months. He has had no change since a procedure he had before COVID. So I told him to ask since he is stable, could they go a year. Dr. told him he wants to do one more test and then seeing DH once a year would be ok. My Mom had bladder cancer at the age of 80. Once she was stable her appts went to once a year. After 5 years, he still wanted to see her and do a scope. By this time she was into her Dementia and living in an AL. She didn't like to be touched and really didn't understand what was going on. So I stopped taking her. If she had gotten bladder cancer again, we would not have treated it anyway.
If Dad is so bad he needs to be transported, I probably would have stopped sending him.
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While it may be different in various places in my experience as an EMT with the local emergency service nursing homes and facilities like that have a contract with transport services to do the non emergency transport so $700 a ride sounds high to me and makes me wonder if there is some internal issue or cut backs they are trying to pass along. I would check your contract and the info given to you when he entered the facility to see if there is any mention of doctor transport. Since it isn’t an emergency transport there are probably hoops to jump through which require the doctors help to get it paid for through Medicare, supplement or Medicaid if that’s possible and the facility again should have info on that, I say should because if they are being lazy and not going through this process for you or telling you what you need to do before presenting a bill...well maybe they are too overwhelmed to stay on top of things they should. Getting the doctors office involved by having them justify the visits to cover transport, if an option, will also determine wether or not the visits are necessary of course. Sometimes everyone gets complacent and continues things that while no longer necessary could be helpful and aren’t hurtful from their perspective and everyone is getting paid, one of the problems with our overwhelmed system. We have on several occasions asked a specialist if the 3 month visits are still necessary and had the doctor easily agree they aren’t, moving Moms follow ups to every 6 months or yearly.
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"...testosterone can also be delivered through injectable small pellets. This treatment is administered every 8 to 12 weeks." Is this why he's going so often? Please find out why.
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One of the many specialists my dad was seeing regularly was a urologist. It became clear this doctor had nothing of value to offer my dad. I’d question whether a urologist is needed any longer. The staff nursing home doctor should be well versed in treating UTI’s
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Why does he have to be seen so frequently?

I would ask the doctor that question first.
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