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My mom is at the very end-stage of Alzheimer's and I had to get her in the Emergency Room several times. Even with mom being unable to walk due to urinary tract infections, Medicare has refused to pay for her 911 EMS rides to the Emergency Room. The ER doctor even wrote as part of her medical diagnosis as threat to life. I appealed this -- several times-- to both Medicare AND her Tricare-for-Life and both are still refusing to pay for it. Is this some kind of death panel they don't want mom treated and just let her die??


Although I am power of attorney (POA), when mom eventually dies I refuse to pay thousands in ambulance services which Medicare and Tri-care are refusing to pay. Can the Ambulance services turn on me for payment? Do I have to pay for her unpaid medical bills when she dies? You are talking about several thousands of dollars when it is nearly $700 for a single ride to the Emergency Room.


What does Medicare and Tri-care expect from me??? Do they just want me to not get mom treated and let her die? I told them both when mom gets a UTI she is so profoundly sick she can't walk to the car, and I cannot lift her up and carry her out to the car. Medicare and Tri-care For Life don't care and just give me the run-around. Tricare even said I filed too many appeals and it was costly administrative time. Then I get a letter from them saying I have to refile the appeal. Seriously! I must have sent them at least ten letters. They are so messed up it is beyond description.


I only pray I do not live as long as mom since Medicare does not like paying for ambulance services. I think they just want a person to die. A friend told me I will not be responsible for her medical bills after mom dies even with me being POA since they are her bills -- just fax them her death certificate. I am wondering if that's true or if someone had something similar.

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Tri care is not exactly a medicare supplement insurance. It is a military benefit. When most of us refer to to tri care it is actually "Tricare for Life". A benefit for retirees. What it pays for is regulated by the department of defense and the Congress and administered by a third party contractor.
Active duty military and their dependents use a different level of tricare.
If medicare does not recognize or approve of the charge then tricare seldom pays.
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Llamalover47 Jun 16, 2019
Then the OP needs to get a Medicare Supp Plan or they never got one. Idk.
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I have an additional suggestion. I have no idea what assets are in her name. If you can show them she has no income and no accounts, I think they will wipe it off.
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First of all, and this is for the future, try to see if there are memberships with the ambulance companies. I pay $35.00 a year and if I am taken by ambulance, I do NOT have to pay for the ambulance. Second of all, these are bills for your mother. When she passes, HER ESTATE is where the money comes from. You do NOT have to pay those bills. Third, if they keep hounding you, tell them they are not going to be paid because.......and if they keep harassing you, you will write letters to the newspapers to be printed and you will contact television studio and have her story put on the news. That will scare them and they may stop. I did this for someone who was constantly being harrassed and nothing was stopping it - until I got it blasted on the media for a five night coverage. After that, everything was in pure peace. Believe me - it works! Remember, YOU DO NOT OWE THEM FROM YOUR MONEY. THEY CAN'T GET IT FROM YOU, ONLY FROM HER OR HER ESTATE. Also, talk to the local Office on Aging for help.
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Just a follow up comment. Tri-Care is secondary payer for Medicare. If Medicare does not pay, tri-care does not usually pay.
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Llamalover47 Jun 15, 2019
Since Tri Care is apparently the Medicare Supp Plan, they should pay - UNLESS the "letter" of the plan dictates no ambulance rides per its contract.
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If Tri Care is her Medicare Supplemental Plan, see what the contract says is covered.
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That's something to consider when choosing a nursing home. Here in Columbus Ohio ambulance transport is free if you call 911 and go to a local hospital. It's part of our taxes.
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JoAnn29 Jun 15, 2019
It is where I live too. But once they hired EMTs, they are now allowed to bill Medicare. We are not responsible for balances. But, they no longer will do nonemergency transports. We have a private company for that.
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If you are certain that you signed all those paper...POA...then you have NO responsibility for any of those bills

if they attempt to harass your Mom (I guess you pick up the phone). Tell them. “It is not alright to contact Mom with phone calls...ever.” Let them write letters.

you will never be responsible for those bills.

once she has died....they can try to collect from her estate if there is one. They will know because they will watch the probate court calendars. BUT, again, you are not ever responsible for your Moms bills
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I called 911 in December after my husband began slurring his speech after taking one dose of a new medication. I thought he was having a stroke, and I could not get him out of the bed. He was taken to the ER and released 6 hours later after receiving IV fluids to "flush" the medicine out of his system. I found him unresponsive in a chair 90 minutes after we came home (by now it was 2:00 in the morning) and so I called 911 again. This time he was admitted to the hospital and was there for five days, very very sick and I think this whole thing advanced his dementia by at least a year. After receiving many bills and finally calling both his insurance company and the ambulance service, I was told the EMT's had written I called 911 because he had urinated on the floor. I'm still trying to get this paid, but who needs all this on top of everything else????
If I ever have to call 911 again, I'm getting a copy of the medic's report asap.
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Countrymouse Jun 12, 2019
That's a very good point, and also a very good example of how it's worthwhile drilling down to the detail of what's on file with the claim.

I had a similar experience with a GP's report, to which I ended up attaching a closely-typed page of addenda, corrigenda and clarifications - 20 questions, virtually every one answered wrongly or incomplete.

But wouldn't it be nice to look that EMT in the eye and say "well? Explain?"
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My mom’s income is very low—poverty level. We looked into programs that help the elderly pay for bills due to their low income and it worked. Unless your mom is extremely rich, you should be able to get some assistance.
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Oh my goodness, I had no idea how expensive an Ambulance ride was in some states. I just spent 2 weeks driving through 9 states and wondered at the number of different ambulance companies I saw even in smaller towns. I guess it is a for profit business? I am glad I had travel medical insurance.

Here in BC there is one Ambulance service for the Province and there are medical transport companies, that provide patient moves in non emergency situations. Those are private companies, but there generally is only one company per region except in a big city.

I once went to bat with the fees we were charged, my husband broke his leg in a remote location. He had 6 different Ambulance rides, from the point of rescue until he got to the hospital where he had surgery. I was able to argue that the first 4 were to get him from the accident location to the first hospital and the second two from the first hospital to the one that could do the complicated surgery. My appeal was accepted and the bill dropped from $300 to $100. Back then a patient paid $50 per ride, now I believe it is $80 per ride.
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igloo572 Jun 12, 2019
Yes can easily be a bill with a comma in it for round trip.

In a lot of areas there will be city or country run EMS supported by tax dollars & community block development grant $. These are easier to deal with imo as they have a system thru city/ co health dept to get paid and can waive the copay on Medicaid patients. (These are outfitted $$$$ vehicles that can be a mini ER or triage unit). It’s the private ambulance services that are much harder to deal with. Lots of places have ambulance co you pay an annual fee to belong to. Kinda like having AAA if you drive a lot. Where we are, it’s Acadian Ambulance and like $100 annual for family plan. I’ll probably do it once we both retire as it’s a good & affordable option just to have.

Imho a lot of the private ambulance bills are inflated semi-scams. For my mom, her 1st NH called City EMS to take her to ER when she appeared to have had a TIA & MediCARE paid. But the return trip after her 36 hr “observation” at hospital was by private ambulance that NH had on call as an outside vendor. It was a transfer run & so not covered benefit by the M&Ms. Ambulance co billed her like $800 which was sent to her at the NH address. Not to me as her DPOA at my address nor to the address that both the M&M had on file for her. Couple months later, another TIA run & a repeat of the above & then a 3rd. In speaking with others this was super common & done way way too much imo., even to get X-rays they would do an ambulance run. This plus other issues, so I moved mom out of this NH to another at abt month 9. Her second NH rarely called ambulance service as they had portable X-ray co to the NH & had couple of isolation rooms they would put residents in for an interim point instead of send to the ER via ambulance as a knee jerk to anything. They did call city EMS though if needed. But I digress, bills finally surfaced almost 2 years later. I told them she was on hospice at the new NH and never heard back or got another bill. Sent them a letter when probate opened and they didn’t file a claim.

When I look back on all this, my gut feeling is majority of private ambulance co NH runs are really just transfers. If I’m accurate, then they are making out like bandits from the bills that do get private paid. Like from hospital door (which has employee to load then into the vehicle) to my mom’s first NH was maybe 30 minutes. Then once at NH, a NH aide met the ambulance & put her into a wheelchair or got her walker so she could get to her room. The ambulance driver really does little. It’s not a driver with a certified EMT in the unit doing O2 or other life saving stuff. It’s not a fully equipped EMS vehicle which is very $$$$. It’s a retrofitted extended van by & large with a driver. Kinda Specialty Uber. My mom sat in a seat from all her “under observation” returns. Add an hr for scheduling & return. So maybe 2 hrs time out tops. If 4 out of 10 not covered by insurers bills get private paid, they are making $.

Its probably a good ? to ask prospective NH as to just how they deal with residents needing services not provided for at the NH as to how they get to those services or appointments. If at all possible you want them in a facility that has mobile units under contract to the NH.
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Medicare is refusing to pay because the situation was deemed by the EMS ambulance as a non-emergency situation (not medically necessary). Please read the Medicare definition of an emergency; like shock, unconscious, or bleeding heavily, or the patient needs skilled medical treatment during transportation.
UTI is a serious situation, but you could have probably brought your Mom to the Hospital ER without the ambulance; like a Medi-Car/Cab service with a wheelchair.
You should be able work out a payment plan with the EMS.
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cetude Jun 17, 2019
Mom is homebound, unable to get in the car even when she's "well" due to advanced Alzheimer's. When she has a UTI she is critically ill. My eldercare attorney fixed it nothing will ever go into probate, so I do not believe EMS can get a dime off of her estate. I accessed the EMS report and the ambulence driver stated she was "stable" which she was not. If she were "stable" I would not have taken her to the emergency room and unable to get up due to her UTI. If the amublence personnel does not know how to chart, they are going to have to suck up the bill because I'm not going to pay her bills when she dies. Yes I am POA, but they are still HER medical bills.
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HI.
Yes, let it go to collections!!!
Ccertainly she isn't working on her credit.!!!
Poa, that was me..
We had no outstanding Bill's....but
Let ambulance co. Try to figure out you have POA! THEY do not have time or staff to go to that length...
FRUSTRATING? YES!!!
just ignore bill...or send $5-
I needed help getting my patient up off floor.. yep I got a bill.
Did I pay it? No!!!
plz don't worry too much... they will even return if you call..
Cindy
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cetude Jun 17, 2019
When mom dies I would like them try to put mom in collections. Try getting money off a dead corpse. My eldercare attorney fixed it nothing will ever go into probate, so it is doubtful they can get anything.
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After the death of a loved one, their executor is responsible for their unpaid medical bills. If Medicare or Tricare refuse to pay for her ambulance rides, you may need to request that the hospital file a new claim to submit to both Medicare and Tricare.
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igloo572 Jun 12, 2019
Executor is NOT personally responsible for paying deceased bills.

What Executor does - in my experience as 1 now 3 times- is as a Executor you or probate atty reviews all properly filed claims against Estate to determine where each claim falls in priority as to payment and then balance that against assets of the Estate. If they actually die with liquid assets - like a large banking balance or an life insurance that has the Estate as the beneficiary - there will be cash $ to Pay creditors who have filed a claim against the estate however probate laws require. The how laws require is important as usually there is a specific order. Secured creditors are up first & foremost, like Mortgage co. That ambulance co. along with credit cards, MERP, utilities, etc. are not secured creditors & they have to wait.

But before this point, Creditors have to file their claim & file in a format as per probate and do so within a limited time frame from the published in a newspaper NOC (notice to creditors). My experience is most independent businesses DO NOT FILE; it’s too cumbersome to do plus has costs to do so gets written off as uncollectable bad debt. It’s the CC, communications co., bigger health care providers that do & they tend have a local or regional collections firm that in turn has independent contractor runners who actually pick a stack of filings up and then the runner goes to the courthouse to fill out the specific probate court info to enter into the docket paperwork for each one, pay usually cash for each filing & get a receipt for each filing. The runner gets paid by the # of filings & reimbursed for parking, mileage & filing fees. Most runners are year 2 or year 3 law students or grad students at whatever Univ that has a law school. It’s a good gig for those with a car & ocd organized. Filing a claim against the estate tends to be something that still done by a person and not via on on-line portal to the CH as that’s usually for attorney of record for the court. Also this way it’s done in real-time with receipts and no lost in the mail story drama. I’ve been in the file your probate stuff here line at more than 1 CH basement with runners, they may have 100+ filings... like 50 AT&T, 40 TMobile and the rest from QuestDiagnotics (this outfit is relentless), & they hit couple of different County CH in a good day & turn in receipts to collections firm by EOD & get paid in short order.

If estate has no liquid cash - like it’s assets is a house or land or a business to get dealt with - it’s maybe months or years till there’s $ to ever pay claims.

Because of that, imo, The smaller debtor kinda needs to do whatever to have bill paid ASAP or get responsibility moved to a still alive family member so they might be able to get bill paid. Otherwise bills kinda toast.
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Can EMS change the ride to a non-emergency medical transport? The last two times I had to call for help I used our non-emergency number to call for a non-emergency medical transport. I had to answer a few questions but I got the transport. Those last two calls stopped the dispatch of the Fire Dept. to our house
and changed the codes for the ambulance.
I found out the hard way that I coud not just call the ambulance company for a transport. I had to call our non-emergency help number.
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cetude Jun 17, 2019
When mom is in serious trouble, I called 911. EMS came in response. When she is sick with fever and unable to move..she needs a trip to the Emergency Room or she could die from infection which can easily turn into SEPSIS and DEATH. She has NO immune system left.
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What reason is given for rejecting the claim?

All insurers will reject a claim if they can, and it doesn't help to take it as an unfeeling, personal affront. But they do have to say why they're rejecting it and then you know what to challenge.

Your POA ceases on your mother's death, and you cannot be personally liable for her bills anyway. But her estate may be, and her executor would then use the money from her estate to settle outstanding debts.
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If I remember correctly, I think moms medicare and supplemental insurance paid $100 leaving a $300 balance owed each time. I paid them $20 a month out of her very limited funds. Of all her bills I really wanted to make sure the EMS guys got at least something. I was still paying on previous trips when she’d need another one. I finally paid them all off during the Medicaid application/spend down when she had a little extra money due to being in rehab and not needing to pay her for apartment.
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Here is how Medicare reads

"Part B covers emergency ambulance services if: An ambulance is medically necessary, meaning it is the only safe way to transport you. The reason for your trip is to receive aMedicare-covered service or to return from receiving care. ... And, the transportationsupplier meets Medicare ambulance requirements."

I guess they feel a UTI is not an emergency. Maybe if she had been kept overnight?

You will not be the one sued, Mom will be. If u aren't worried about her credit score, don't pay. Or in "good faith" set up a payment plan and pay what Mom can afford monthly, lets say $50. That goes for any medical bills. But get it in writing. Years ago my Aunt set up a payment plan and the hospital still sent her to collections. TG it was a lawyer. She told him and he said just continue paying him the agreement.

When Mom passes the debt is hers and the estate is responsible for the bills. No money the bills go unpaid. POA stops and the Executor takes over.

If Mom is low income, you may want to apply for Medicaid health insurance. What Medicare doesn't pay Medicaid does.
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Rabanette Jun 12, 2019
UTI is a medical emergency in a senior with dementia, as it can cause serious personality swings and other serious side effects. It can cause aggression, anger, agitation, confusion, and disorientation.
Those would seem to be serious issues that could cause harm to others or the patient.
I don't know the ambulance trip is separated from the rest of health care. It's so frustrating!
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My mom was taken by ambulance to hospital once for something that turned out to be non emergency (she has dementia & really can’t talk so it’s not that easy to know!). Her Dr. had even said call the ambulance. She’s on Medicare & has a supplemental. But because Medicare wouldn’t pay, neither would the supplemental. Mom was stuck paying around a $1000.

(In my area we don’t have membership fees for ambulance or fire services)
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worriedinCali Jun 10, 2019
My area doesn’t have ambulance membership fees either. There is a $50 annual membership cal star though so if you need to be flown to the hospital, you’re covered. By there’s no ambulance membership anywhere around here.
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EMS will not come after "you" to pay mom's bills. They will come after you, as POA, for mom. Hopefully, you signed as "Cetude" as POA for MomCetude. If not paid they will file a claim on any estate there will be. Is there a transport company that would come get her instead of using ambulance and lights and siren? A non-emergency response?


Some areas have memberships to EMS services. In my area it is $50.00 a year. With that fee paid, any emergency transport is not billed, included in the membership. EMS here uses it as a fund raiser for much needed equipment, and well worth the cost!
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When this happened with my mom, I discovered that the ER and the ambulance service had both Ms filed the claim the wrong way with Medicare—one of those infernal “code” mix-ups. Sad to say, I never could get it figured out and Mom wound up paying $750 that was never reimbursed.
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