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DarkCloud Asked June 2019

Does any insurance cover transportation from skilled nursing facility for medically necessary procedures?

97yroldmom Jul 2019
Yes Dark Cloud it is a learn as you go program with a lot of gotchas with our health care.
Some of the Medicare alternative programs seem to lure folks over by offering “free” services like transport to drs, eyeglasses, dental etc. My experience (several years ago) was that Other options like which doctor or HH or rehab etc weren’t as generous. So you get about what you pay for was the lesson for me. I’ve heard if you are in a large metro area those plans can work. Not so much otherwise.
I had a dear friend on that program and she was always getting the run around with the transport providers. She wanted to be independent and not ask her son to help her.
Your father is lucky to have you.

JoAnn29 Jun 2019
CM gave u the Medicare info but I would call them to verify. Check with ur supplemental too. Each one is different depending on how much u pay.
DarkCloud Jul 2019
Thank you JoAnn! Unfortunately, this appears to be a private pay expense we will have to bear...

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Countrymouse Jun 2019
Well. Bearing in mind I'm not in the USA, this is what eHealth says:

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Medicare generally does not cover transportation to get routine health care. However, it may cover non-emergency ambulance transportation to and from a health-care provider if you need to have a health condition diagnosed or treated and other forms of transportation could endanger your health. Your doctor must provide a written order verifying that ambulance transportation is medically necessary because of your health condition.

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So it seems that *medically* *necessary* transportation might be an eligible expense, which is what I'd assumed - insurers naturally prefer to cover things that are unlikely to happen, but NEVER covering something that common would leave gaping holes in their customers' protection.

I then started comparing Medicare plans and lost the will to live. Go through any policy with a fine-toothed comb before you buy.
DarkCloud Jul 2019
Thank you Countrymouse - I just hope these journeys out of the SNF will be limited but have the feeling there will be more than I expected.
DeeAnna Jun 2019
Most skilled nursing facilities or long term care facilities will transport a resident to and from doctor appointments; however, they do not stay with the resident during the doctor appointment.  If you want to attend the doctor appointment, then you need to meet your loved one at the doctor's office.

If the "medically necessary procedures" are outpatient surgery, some facilities will transport a resident to and from the hospital, but again, they will not stay with the resident prior to surgery (pre-op), during surgery, or after the surgery (post-op).  If someone needs to be with the resident while they are at the hospital, then you need to go to the hospital and stay with your loved one.  Sometimes you can hire an agency person to stay with your loved one at these appointments or procedures.

If the resident is cognitively impaired, then the "Medical POA" or "POA For Healthcare" should be at the procedure so that they can sign the consent forms for the procedure and talk to the doctor before and/or after the procedure.
DarkCloud Jul 2019
Thanks DeeAnna - didn't seem to matter if the procedure was medically necessary or not (IMO it was). Strangely, even the employees in the business office of the SNF were surprisingly unsure of the Medicare/supplement rules even though you know this is a daily occurrence. Makes me wonder if there's something else going on with these SNFs and the local transportation service companies. Thanks again!

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