mom's ambulance bill advice

[anethum]

A couple of months ago, my mom fell and fractured her hip. She was transported to a hospital by local government ambulance, and a few days later after an operation, was sent home by private ambulance to her home. It was arranged by the hospital. She recently received a deceptive letter, IMO, from the private ambulance company which brought her home. She had not previously received a bill or other correspondence from them. In large font in all caps on the letter/bill are the words:

"SIGNATURE REQUEST FORM PAST DUE"

"SIGNATURE REQUIRED IN ORDER TO FILE AMBULANCE CLAIM"

It sounds dubious to me that they need a signature to bill Medicare. Moreover, I don't believe that Medicare pays for ambulance service from a hospital to home, but am not certain.

The red flag for me is that the letter has small print above the signature line which includes the following sentences:

"I authorize the submission of a claim for payment to Medicare, Medicaid, or any other payor for any services provided to me in the past, present or in the future, until such times as I revoke this authorization in writing."

There is also the language: "I understand that I am financially responsible for the services and supplies provided to me, regardless of my insurance coverage..."

I suspect the purpose is to get the patient to acknowledge in writing that they're are responsible for the bill, by misleading them into thinking the purpose for the signature is to bill insurance, which is unlikely to pay anything.

BTW, mom's local government bills Medicare for transportation to a hospital in order to recoup some of the expense, but they do not bill residents. The local government billed Medicare for two related ambulance charges totaling $527.20, Medicare allowed charges of $461.54, 80% paid by Medicare, 20% paid by mom's Medigap plan. The private company bill is for $939.29. I can certainly pay the bill in whole or in part without signing the "Patient Signature Statement". I can also ignore the letter.

FWIW, the ambulance ride was about 10 minutes each time, and if anything, was simpler when she was transported home because she was no longer in severe pain.

I handle my mom's finances. I am not averse to paying at least an amount equal to the Medicare allowed charges. I am not sure I want to pay the full amount, after reading lots of bad press about the company and the wording of their letter/bill. Mom is 99 years old, has dementia, and has needed 24/7 home care for several years. She recently began home hospice.

Any advice about how to handle this? I have thought about phoning them and attempting to negotiate the amount, since there's not much they can do to my mom given her age and health.

 

[Montecfo]

I got a crazy ambulance bill a couple of years ago. It was out of network.But of course I had no choice in the provider, and frankly didn't think I needed to ride in an ambulance between hospitals. So I was prepared to fight it.

I called the ambulance company to find out what the deal was and in the course of explaining their policies, they told me that if I was unemployed they would credit me the full charge. It was about an $800 bill.

To prove I was not employed they asked me to send my bank statements for 2 months to them. I sent them the bank statements, omitting the account numbers, which showed the only deposits into the account were from my savings.

They credited the charge, and there was nothing adverse with credit bureaus or anything else.

I did sign a statement stating that these documents I was providing were true and correct, and they were.I was not asked to sign any document to say I was admitting I was responsible for the bill, because the purpose of my call was to assert that I shouldn't be charged out of network for something that I had no choice in and didn't feel I needed.

So in my opinion a call to the ambulance company is your next step.

 

[Walt34]

"I authorize the submission of a claim for payment to Medicare, Medicaid, or any other payor for any services provided to me in the past, present or in the future, until such times as I revoke this authorization in writing."

Bolding is by me. I would flat-out refuse to sign that.

 

[Aerides]

I'd probably call the hospital - they picked em. This is the exact sort of surprise billing that is prevented after this year.

 

[Golden sunsets]

Was she on hospice when she was transferred to/from the hospital?

I ask because my DM, who was living in a memory care facility, and on hospice, had a fall in early 2020. resulting in fractured pelvice. She was transferred by ambulance to the ER and then by a different ambulance service to a recovery facility, where she passed away shortly thereafter(her death is irrelevant I think). Both ambulance charges were initially denied by Medicare because she was in hospice. They both appealed and Medicare did reverse their position on the claims, but it took a long time. Both ambulance firms charged off the amount uncovered by Medicare.

 

[latexman]

I’d give them Mom’s Medicare number, and not a penny more until I see an EOB and some adjustments.

No signature!

 

[anethum]

Thanks for the comments so far. Rest assured, I have no intention of signing their ridiculous statement.

No, mom was not on hospice at the time of either ambulance transport.

My best understanding from what I read on the Medicare site is that Medicare would likely pay for ambulance transportation from a hospital to another facility, but not to take a patient back home.

Here's a link to a Medicare page about ambulance service:

https://www.medicare.gov/coverage/ambulance-services

The following language is interesting:

The ambulance company must give you an "Advance Beneficiary Notice of Noncoverage (ABN)" when both of these apply:

You got ambulance services in a non-emergency situation.
The ambulance company believes that Medicare may not pay for your specific ambulance service.

My mom was not given an "Advance Beneficiary Notice of Noncoverage".

edit:
I presume that the ambulance company has my mom's insurance information, because their form does not ask for it, and they obviously were given my mom's name & address by the hospital because they mailed her the bill/form.

 

[pacergal]

If she was not given the ABN, then she is not responsible for the bill.
At least that was my understanding from the health dept I worked for. If we didn't get it signed by the patient before lab work was done, we could not bill them.

 

[CRLLS]

Thanks for the comments so far. Rest assured, I have no intention of signing their ridiculous statement.

No, mom was not on hospice at the time of either ambulance transport.

My best understanding from what I read on the Medicare site is that Medicare would likely pay for ambulance transportation from a hospital to another facility, but not to take a patient back home.

Here's a link to a Medicare page about ambulance service:

https://www.medicare.gov/coverage/ambulance-services

The following language is interesting:

The ambulance company must give you an "Advance Beneficiary Notice of Noncoverage (ABN)" when both of these apply:

You got ambulance services in a non-emergency situation.
The ambulance company believes that Medicare may not pay for your specific ambulance service.

My mom was not given an "Advance Beneficiary Notice of Noncoverage".

edit:
I presume that the ambulance company has my mom's insurance information, because their form does not ask for it, and they obviously were given my mom's name & address by the hospital because they mailed her the bill/form.

You are not responsible for your mother's ambulance bills.

There is also the language: "I understand that I am financially responsible for the services and supplies provided to me, regardless of my insurance coverage..."

1st of all, IANAL. I would simply have your mother strike out the sentences you disagree with, Initial and date the change in the margin and sign the rest so they can bill Medicare. BTW, keep a scanned copy of the doc after signing.

I might also contact the hospital for clarification of the bill if they were the ones who ordered the ambulance.

 

[pb4uski]

And why an ambulance to go home? I've never heard of that

It sounds like the hospital ordered the private ambulance so the ambulance company should bill the hospital and the hospital can then bill Medicare.... right? Unless you or your mom signed something requesting service then how could it be that you are their customer? That would be my position out of the gate... puts the onus on them.

I can just see the judge.... Mr. Ambulance do you have documentation signed by 99yo agreeing to pay for your services? Well, your honor, we don't have that. Well then , what the heck are you doing here then?

 

[MrsHaloFIRE]

Agree would take no action until i see a medicare EOB. Theyd rather go after you for full rack rate than get their negotiated medicare rate I think.

 

[John Galt III]

Have not read the whole thread, but I can tell you the ambulance people are very sleazy in general. My mom received two $300 copay bills from 2 different ambulance companies for the same event. Both amb companies showed up, and only one took her to the hospital. She ended up paying both bills, for God's sake. Awful. Her insurance company paid their measly $45 for both bills also. Insurance company said it was all legit, just pay up, sucker. Another horror story: my father was taken by ambulance from one hospital bldg to another. Non emergency. Could have called a cab, not informed though. Less than a mile, gets a bill for $300 copay. Ends up paying it. Never was informed he would be charged. Ambulance companies are just s__mbags, plain and simple. Avoid whenever possible. I make a point of driving my mom to and from hospital, whenever possible. They love to prey on old folks.

 

[ivinsfan]

In our area the ambulances are either local volunteer rescue squad or owner by the large entity that runs our local clinic and hospital so not sleazy.

Make it easier to deal with them anyway. They both sent bills for my MIL and FIL at one time or another but generally just take whatever your insurance would pay.

Randomly in a complete act of jerkiness my MIL was at a group living home think 6 people with some early dementia. The night staff didn't like her because she did some sunsetting and ruined their peace and quiet.. (think napping on the sofa). One night MIL wanted to watch TV and it somehow turned into the staff member calling the police because MIL threw the tv remote. the local ambulance was called and dumped MIL at the ER 20 miles away. Medicare wouldn't pay for it, I guess I don't blame them.

I paid the ambo and then negotiate most of the cost back from the last bill at the assisted living. I made call a lot to get that last payment and wasn't too pleasant about it.

 

[The Cosmic Avenger]

And why an ambulance to go home? I've never heard of that

It sounds like the hospital ordered the private ambulance so the ambulance company should bill the hospital and the hospital can then bill Medicare.... right? Unless you or your mom signed something requesting service then how could it be that you are their customer? That would be my position out of the gate... puts the onus on them.

I can just see the judge.... Mr. Ambulance do you have documentation signed by 99yo agreeing to pay for your services? Well, your honor, we don't have that. Well then , what the heck are you doing here then?

When I worked as an EMT for a private ambulance company, it was my understanding that we did routine (non-emergency) transportation for patients who were on oxygen or had certain conditions that meant they might need emergency medical care during transport, or who were confined to a wheelchair and could not transfer between their residence and a vehicle without being carried. We did take some patients like that home from the hospital, but most often we took dialysis patients with end-stage renal disease to and from their dialysis.

I have no idea about billing, I wasn't involved with that at all.

 

[pb4uski]

I can see that there might be some rare cases where a patient might need an ambulance to go home, but they should be pretty rare... which is why I asked the OP why?

If a patient might need emergency medical care during transport, why would they be being discharged and sent home even to begin with (assuming that they would not have access to emergency medical care at home)? I would think that would be very rare.

There may be good reasons why the OP's mom was sent home by ambulance, but I'm skeptical to begin with.

 

[ivinsfan]

I can see that there might be some rare cases where a patient might need an ambulance to go home, but they should be pretty rare... which is why I asked the OP why?

If a patient might need emergency medical care during transport, why would they be being discharged and sent home even to begin with (assuming that they would not have access to emergency medical care at home)? I would think that would be very rare.

There may be good reasons why the OP's mom was sent home by ambulance, but I'm skeptical to begin with.

Maybe because she had a broken hip, is 99 and has dementia. In retrospect it would have cheaper to have one of her caregivers pick her up and take her home. But I don't see any shadiness going on here...

 

[pb4uski]

I guess we'll need to see if the OP comes back with an answer.

 

[HarveyS]

Any advice about how to handle this?

In your shoes I would call and try to negotiate. Then pay the bill for a service rendered.

 

[gauss]

The local Fire Department here provides ambulance/EMS service.

On multiple times, I have had to have my DM sign a statement in order for them to submit the bill to Medicare for reimbursement.

She signed and we have not had an issue both times -- other than paying our cost share. They may have been out of network so the cost share may have been non-trivial.

-gauss

 

[anethum]

As I explained in my first post, my mom had fallen and fractured her hip. She had severe pain with the slightest movement. She had to be literally carried in a sling by the EMT folks into the ambulance to get to the hospital. An orthopedic surgeon inserted a rod to hold her hip together for the rest of her life. She's 99 years old. She was discharged 2 days after surgery. She once again needed to be carried in and out of the ambulance, and up stairs inside her house to her bedroom, but at least she was no longer in pain and a sling wasn't necessary. The purpose of the surgery was to relieve her dire pain. The choice was that or immediate hospice. Given that she had dire pain in the hospital despite being given morphine, the decision was easy.

Amazingly, a physical therapist was able to get her to walk short distances with a walker w/wheels. It took 10 sessions (at home), and about 6 weeks. Prior to this recent fall, my mom could not only still walk, but could still go up and down stairs, with help. I wanted her to finish the therapy before she began home hospice. Otherwise, I don't think Medicare would have paid for the therapy.

I was called multiple times while my mom was hospitalized for 4 days, in order to give consent for a blood transfusion, to the orthopedic surgeon to perform the surgery, and to the anesthesiologist. I was not asked anything about an ambulance to get her home, only told that they would send her home via ambulance. The ambulance service had a contraption on wheels to get her into her house, and physically carried her while laying in the contraption up to her bedroom. I saw something similar once in a national park when a hiker had broken her ankle and had to be evacuated by a rescue team.

Several years earlier, my mom had fallen and fractured her pelvis & one wrist. She was moved from a hospital to their rehab facility (which didn't require even going outside), where she got physical therapy for 20 days. I was very impressed with the physical therapists, and they had her walking with a walker when she was discharged. I drove her home in my car, and that's when her 24/7 homecare began. BTW, within 2 weeks of getting home, she had graduated from a walker, to a cane, to walking unaided. One of the PTs told me that people recover much more easily from pelvis fractures than hip fractures.

She had stitches and bandages over the 2 relatively small incisions from the surgery. The discharge instructions said the call the orthopedist's office to schedule removal of stitches and bandages. I called the office and explained that my mom is not ambulatory and I could not take her to their office. When I asked the office staff if I could instead get a nurse to remove the stitches & bandages (from the agency which was providing the 2 therapists), they said no. Fortunately, the physical therapist said she could do it and she spoke with the orthopedist (not his staff) who was fine with it. I was very grateful that the PT took the initiative.

 

[pb4uski]

...."I authorize the submission of a claim for payment to Medicare, Medicaid, or any other payor for any services provided to me in the past, present or in the future, until such times as I revoke this authorization in writing."

There is also the language: "I understand that I am financially responsible for the services and supplies provided to me, regardless of my insurance coverage..."...

I think I would sign the first part and strikethrough the last part... that would allow them to bill Medicare. From what I found below and what you posted above it sounds like your mom's return home by ambulance was medically necessary because she was unable to walk. Also, assuming that she did NOT receive an ABN that would suggest that the ambulance company believed that Medicare would pay for her transportation.

You may be eligible for covered non-emergency ambulance transportation if your health requires monitoring, and travel via a standard vehicle could be hazardous given your condition. To qualify for non-emergency ambulance service, your physician must write an order stating that ambulance transportation is necessary. You must also be confined to a bed (meaning, unable to walk or sit in a wheelchair) or need medical services during your trip that are only available in an ambulance setting, such as monitoring or IV medication.

When you receive ambulance transportation for a non-emergency situation, the ambulance company providing that ride must provide you with an Advance Beneficiary Notice of Noncoverage (ABN) if it believes that Medicare may not pay for your transportation. At that point, you’ll have the option to decide whether you want to be transported by ambulance or not, and you’ll be forced to acknowledge that you’re responsible for covering that cost if Medicare doesn’t end up paying. You may also be required to pay for your ambulance service up front.

 

[The Cosmic Avenger]

Glad your mom is doing well, anethum. The ambulance definitely sounds necessary, but I agree that I wouldn't sign what you mentioned, it's too broad. Maybe the hospital can advise you? Or maybe 1-800-MEDICARE, the government hotline for Medicare questions.

 

[CardsFan]

I will be the contrarian here. The wording of the document sounds like every document I have ever signed in every hospital or doctor's office I have been in.

They ask you to give permission to bill the your insurance, but ask to to accept that you are ultimately responsible. Really not unreasonable. They are entitled to get paid for a service. And, after clarification from OP, it sounds like the ambulance service was necessary. BUT, have her sign the document, if possible.

If they are unscrupulous (out of network, trying to get more) you will eventually find out. Then just don't pay. I don't think OP's mom is worried about a ding on the credit rating.

 

[RetMD21]

They ask you to give permission to bill the your insurance, but ask to to accept that you are ultimately responsible. Really not unreasonable. They are entitled to get paid for a service.

For Medicare covered services this isn't the case but they ask you to sign anyway.

 

[CardsFan]

For Medicare covered services this isn't the case but they ask you to sign anyway.

That's interesting. I have only been on Medicare for 6 months, but I see the same request on every document I get. Are you saying they are not allowed to require this?