mom's ambulance bill advice

[RetMD21]

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?

They can ask you to sign it but they can't enforce it. They are obligated to bill Medicare. You are liable for any deductibles of copays of course.

They should ask you to sign an ABN If the service will not be covered.

There a a few physicians who have entirely opted out of Medicare (which is different from nonparticipating status) and they can bill whatever they want.

 

[pb4uski]

RetMD21.... so it seems like you are saying that the most that they can bill a Medicare patient is the Medicare rate for the service less what Medicare pays... that might make sense if the service is covered by Medicare.

But if the ultimate result is that the service provided is not covered by Medicare then I wouldn't think there is any limit on what the provider can bill and by signing the financial responsibility sentence then the OP's mom would be on the hook for the $939.29 billed rather than the $461.54 allowed by Medicare.

If I were in the OP's position, I'd be ok with paying $461.54 less whatever is paid by Medicare, or perhaps even the $527.20... but not the $939.29.

 

[ivinsfan]

RetMD21.... so it seems like you are saying that the most that they can bill a Medicare patient is the Medicare rate for the service less what Medicare pays... that might make sense if the service is covered by Medicare.

But if the ultimate result is that the service provided is not covered by Medicare then I wouldn't think there is any limit on what the provider can bill and by signing the financial responsibility sentence then the OP's mom would be on the hook for the $939.29 billed rather than the $461.54 allowed by Medicare.

If I were in the OP's position, I'd be ok with paying $461.54 less whatever is paid by Medicare, or perhaps even the $527.20... but not the $939.29.

I don't disagree, yet Mom is having all kind of health issues and needing all kind of attention. If I ended up owing the rack rate after nicely asking for a discount, I wouldn't put a ton of effort int it ...sometimes you need to pick and choose what you worry about.

 

[Sunset]

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.

While it's true, the document seems much like every document they have you sign as you are waiting to go into surgery. At that point what choice do you have.

But here they want the document signed after the fact, and if signed the recourse they have if OP's mother does not pay some high bill is: ding the credit report, AND sue her for the money, or sell the bill to a bill collector, along with adding fees for non-payment.

Basically there is a danger worse than credit report ding.
Avoided by to striking out the total obligations and sign the paper if one is going to sign it at all.

 

[RetMD21]

RetMD21.... so it seems like you are saying that the most that they can bill a Medicare patient is the Medicare rate for the service less what Medicare pays... that might make sense if the service is covered by Medicare.

But if the ultimate result is that the service provided is not covered by Medicare then I wouldn't think there is any limit on what the provider can bill and by signing the financial responsibility sentence then the OP's mom would be on the hook for the $939.29 billed rather than the $461.54 allowed by Medicare.

If I were in the OP's position, I'd be ok with paying $461.54 less whatever is paid by Medicare, or perhaps even the $527.20... but not the $939.29.

The charge is exorbitant. I don't know if Medicare will pay (traditional/MAC may make a difference) They can submit it to Medicare. look at this: https://www.medicare.gov/coverage/a.../www.medicare.gov/coverage/ambulance-services

It has to be medically necessary, whatever than means. It has to be ordered by a doctor which I think you can assume. They should have documentation of that. She may have been entitled to a ABN. As others have said, until the claim is rejected by Medicare I think it is unwise to do anything. I have disputed claims for my mother successfully but I'm no expert. You can appeal an adverse medicare decision. If is medically necessary non-emergency trtansport it seems like it should be even cheaper

 

[anethum]

UPDATE

I left 3 voicemails over several days with the person at my mom's hospital who handled my mom's discharge paperwork. After waiting for several days without a callback, I escalated it yesterday and reached a very helpful hospital employee. I explained the situation about the ambulance bill and asked whether a physician had ordered an ambulance to take my mom home. He said he'd research my mom's discharge and would call me back. He called me back today and said that there was, in fact, a "Certificate of Medical Necessity" which may not have been transmitted to the ambulance company, or did not get properly processed by the company. He said he was re-submitting it to them. He advised me that if, in the meantime, Medicare rejects the ambulance claim, to appeal it. As of yesterday, no claim for the ambulance was on the Medicare website. I have not contacted the ambulance company thus far. With any luck, this should ultimately get paid by Medicare.

 

[Sunset]

UPDATE

I left 3 voicemails over several days with the person at my mom's hospital who handled my mom's discharge paperwork. After waiting for several days without a callback, I escalated it yesterday and reached a very helpful hospital employee. I explained the situation about the ambulance bill and asked whether a physician had ordered an ambulance to take my mom home. He said he'd research my mom's discharge and would call me back. He called me back today and said that there was, in fact, a "Certificate of Medical Necessity" which may not have been transmitted to the ambulance company, or did not get properly processed by the company. He said he was re-submitting it to them. He advised me that if, in the meantime, Medicare rejects the ambulance claim, to appeal it. As of yesterday, no claim for the ambulance was on the Medicare website. I have not contacted the ambulance company thus far. With any luck, this should ultimately get paid by Medicare.

Great news.
Appreciate the update, as it's informative.

 

[RetMD21]

I have limited experience with Medicare ambulance claims. My mother went to one ER and was transferred to an affiliated larger hospital for specialized care. She was billed something like $1,000. The ambulance company asked her (me) if she was admitted to the first facility or transferred as an outpatient. I wrote back in her name and said that she didn't know and that we wouldn't be paying unless I saw an ABN. They just went away. I think it was easier to bill my mother for list price than put in the effort to clarify things with the hospital and get the reduced rate.

I have had many issues with physician offices and even hospital labs billing for things that had been paid already by her supplement.

 

[Katsmeow]

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

My understanding is that the one big thing left out of the new legislations is surprise billing on ground ambulances (air ambulances are included). As I recall, it was because ambulance billing is more complicated and there wasn't time to work out everything. I think they intend to take it up at a later time....

 

[frances]

I ABSOLUTELY would not sign that bill, and I would tell them to bill Medicare.
If you sign anything it may give the ambulance company a way to say you've agreed to pay if Medicare refuses.
I'm fighting a bill currently with a clinic my mom was referred to by her cardiologist. Medicare refused to pay a couple of charges for tests the clinic decided to do and Medicare said were "medically unnecessary". I appealed the decision with Medicare and was told the charges were denied AND that with their investigation Medicare decided mom was not responsible for the charges because the clinic could not show that they has notified mom before the tests that they would not be covered.
I had made a couple of payments and when I found out this information I respectfully requested the payments back. I was ignored so I did a charge back on the credit card.
It has now been nearly a year since the date of service and this is still on-going, but I expect that in the next couple of weeks I'll hear that the 3rd party that's "auditing" the bill will tell the clinic to pound salt.
This same clinic ended up putting mom in the hospital for a couple of weeks last year with a treatment they gave her (IV Lasix push), all the while us telling them she has kidney failure but they did it anyway....

So long comment short - if you don't agree with a charge from someone and it's going to possibly paid by Medicare by all means fight it!

 

[NXR7]

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

No, actually it's not. Congress specifically exempted ambulance services from that "surprise billing" ban.

The articles I read said that Congress thought there were too many ambulance services, small to large, with too many varied needs and a "surprise billing" ban could unfairly hurt some of them.

Ray

 

[Lstansbury]

Let them bill Medicare and Medicare will send you the denial

Then you can work through the appeals process if necessary.

I worked as a Medicare contractor for 3 years in billing and quality issues. Took "bene" calls and talked about ABNs and discharge appeals all day. And the number one issue we deal with? .... -- ambulance billing. Not getting the certificate of medical necessity to the ambulance company (from the hospital) is often the primary reason that that payment is denied, so follow up on that.

And please don't give them your mother's Medicare number. The Medicare Fraud and Abuse is out of control -- it starts with the Medicare number. If they don't already have it from the hospital, who ordered the service, then something is weird.

 

[old medic]

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".

Being she was being transferred following hip surgery, the hospital discharge should have had a medical necessity form signed by the Dr so no ABN would have been needed.

 

[anethum]

UPDATE & presumed resolution

Medicare just processed the private ambulance bill. The submitted bill was for $939.29, of which $860.99 was for a "private ambulance", and $78.30 was for mileage. (The distance driven was 3 miles.) Medicare approved $273.22 for the ambulance, and $22.86 for mileage. Medicare paid 80% of these approved amounts, and I expect my mom's Medigap supplemental to pay the remaining 20%.

I noticed that Medicare approved a higher amount for the local government ambulance which took her to the hospital because that was deemed "emergency" transport, whereas her private ambulance trip home was after successful surgery and was not considered emergency transport. Indeed, it was much easier to move mom in and out of the ambulance after the surgery.

I did not sign the ambulance company's misleading "Signature Request Form", and never contacted them regarding their form/bill. But as I previously wrote, I contacted the hospital and they sent (or re-sent, I'll never know) a "Certificate of Medical Necessity" to the private ambulance company.

I may send a copy of the "Signature Request Form" to my mom's state Attorney General's office to complain about the sleazy manner in which the ambulance company attempted to get a signature under false pretenses from a 99 year old woman, in which she would have agreed to be responsible for the entire highly inflated bill. The Signature Request Form falsely states in all caps: "SIGNATURE REQUIRED IN ORDER TO FILE AMBULANCE CLAIM".

 

[Lstansbury]

UPDATE & presumed resolution

Medicare just processed the private ambulance bill. The submitted bill was for $939.29, of which $860.99 was for a "private ambulance", and $78.30 was for mileage. (The distance driven was 3 miles.) Medicare approved $273.22 for the ambulance, and $22.86 for mileage. Medicare paid 80% of these approved amounts, and I expect my mom's Medigap supplemental to pay the remaining 20%.

I noticed that Medicare approved a higher amount for the local government ambulance which took her to the hospital because that was deemed "emergency" transport, whereas her private ambulance trip home was after successful surgery and was not considered emergency transport. Indeed, it was much easier to move mom in and out of the ambulance after the surgery.

I did not sign the ambulance company's misleading "Signature Request Form", and never contacted them regarding their form/bill. But as I previously wrote, I contacted the hospital and they sent (or re-sent, I'll never know) a "Certificate of Medical Necessity" to the private ambulance company.

I may send a copy of the "Signature Request Form" to my mom's state Attorney General's office to complain about the sleazy manner in which the ambulance company attempted to get a signature under false pretenses from a 99 year old woman, in which she would have agreed to be responsible for the entire highly inflated bill. The Signature Request Form falsely states in all caps: "SIGNATURE REQUIRED IN ORDER TO FILE AMBULANCE CLAIM".

Congratulations -- you are now a Medicare Beneficiary super advocate! Would you consider also call the Medicare Fraud/Abuse hotline. This may not fall under Fraud, not sure, but it certainly falls under Abuse. Here is the number

Calling us at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
If you’re in a Medicare Advantage Plan, call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-7SAFERX (1-877-772-3379).

This group has caught providers we NEVER dreamed would be bilking the government and taxpayers out of money -- millions of dollars -- and the providers are now in jail. Sad but true.

 

[RetMD21]

unconscionable but I am sure that people just pay up sometimes

 

[ERObjd]

I know that ambulance in Lincoln ne outsource billing to some shady company in Buffalo NY for some reason. I am Tricae and ambulance is covered with a $90 copay. Yet these crooks kept trying to bill me for $1,000.00. I called Tricare ombundsman and let them deal with it. This company called 3-4 times a day and I had to put them on my blocklist. It should be illegal what they do. My isurance already paid the bill. These dirtbags wer hoping to get paid as well. Sad thing is some people cave into the bully tactics and pay it.