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Hi all,


My father is a nursing home resident. He is going to be transferred to another nursing home that is closer to the family. The nursing home wants the family to pay for the ambulance service or else my father will not be transferred to the new nursing home. We asked for them to submit the bill to his insurance company but they said it doesn't work that way. Are ambulance and/or ambulette services covered through insurance (Medicaid Managed Long Term Care and Medicare) when nursing home resident gets discharged from one nursing home to transfer to another nursing home? He lives in the state of NY and one thing I know for sure is that Medicaid definitely pays for transportation when the member has a medical appointment and needs to go to a doctor/hospital.


Thank you for reading, all responses are greatly appreciated.

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ask the case manager for his Medicaid. If the move is motivated by family convenience and not medically related for treatment plan, the transport will probably not be covered by insurance. But ask the case manager. The facility he’s leaving is not going to go to bat to get you help. Ask the receiving facility if they can help.
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shad250 Mar 2019
If it is a routine medical and not emergency, they could have to be paid upfront.
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I don’t think his current nursing home can bill your father’s insurance company for the transport to another. You may have to pay out of pocket and then submit the bill to your father’s insurance company for reimbursement.
I am not sure there would be a code to bill for that. If a facility doesn’t have an ICD10 code or a CPT code to bill for a medically justifiable expense, they won’t bill because they won’t get paid. Thus why I do not think his current nursing home will assume responsibility for payment as they may not get their money back. Why should they, when you think of it? It’s a voluntary transfer.
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shad250 Mar 2019
Only thing NH is doing is calling Ambulance service? Ambulance is doing transport. NH gets its cut after service is paid.
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There are all kinds of answers. Speak to the heads of the facilities and get information from them as to what they know. Find out who the transporting company will be and talk directly to their billing department. Then call Medicare for their rules and guidelines. Last but not least, for about $30 a year, anyone can join an ambulance group and you are guaranteed five rides per year as long as it is medically necessary. There is no one set answer. It needs to be explored but the answers are out there. Personally, from my own experience, I believe is one is being transferred from one hospital to another, it is always l00% covered - but check it out.
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Cherrysoda Mar 2019
Do you have a link to this ambulance group, never heard of such a thing, sounds great.
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Short answer, no transport to another nursing home is not a covered expense.

Family could do the transport at no cost other than gas, time and lodging if necessary.

Since this move is to be closer to family, I wonder where is he and where will be be going? What is the distance that he will be moving?
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Talk to the Doctor. The Doctor should be able to justify a medical necessity reason for an ambulance transport. It could be psychological and/or behavioral. Have the Doctor place the order.
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I don't like the veiled threat, which makes me suspicious of the relationship.  I had a friend whose husband was moved at great expense once, and the next time she knew better and in spite of lewy body dementia, it worked out okay and she drove him the distance herself.
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jacobsonbob Mar 2019
It's ALWAYS a good idea to be "suspicious of the relationship". If one doesn't actually need medical care during the transport, it probably makes sense to do it yourself--even renting a van and enlisting/paying for help will be much less expensive.

A few years ago my mother had an appointment with a dentist literally across the street from the nursing home. My sister and I got her into her wheelchair and pushed it the few hundred feet to the dentist!
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When my wife finished rehab at one SNF, which said they did not have a LT Medicaid bed, she was transferred to another SNF at my expense. I was told that neither Medicare or Medicaid would pay for transfer from one SNF to another. However if she had gone to the ED and then to a different facility, they would have paid for both trips.
Don't expect to get them to pay for any out of state transfer.(You did not specify if that was the case or not)
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Manson Mar 2019
What is ED? I keep hearing that every now and then when my mother was in a SNF and I forgot to ask SNF what that meant.
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When my dad moved from one rehab to another the receiving rehab did everything, the one he was leaving had to have their tail twisted to send his paperwork and get him ready to leave.

Just like a spoiled child that isn't getting their way.
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The ambulance service may not have the ablility to bill Medicare or Medicaid. There is a process that these type of services have to go thru to be approved to bill Medicare or Medicaid. Like said this is not a Medical necessity. When my MIL was going to be transported from Fla to Ga it was 2k and out of pocket.
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In PA, it’s private pay or co-insurance is involved. But still a hefty $$
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