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My mother fell and hit her head at her memory care facility. They called me to tell me, but I was over four hours away. I called my uncle and he said he would go down first thing in the morning, but ended up going at midnight since he was so worried he couldn't sleep. The hospital had him take her back to her facility. What would have happened had my uncle not been available to do that? Since she wasn't admitted, I am told we will have to personally pay for the ambulance, not her insurance. Anyone know about this?

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To the best of my knowledge Medicare does not pay for transportation by ambulances. This seems very unfair and since Medicars doesn't a secondary won't. The cost also is high even if it is just a basic transportation.

Awhile back my mother fell outside her AL facility. She was using her walker and was with my daughter. Personally I feel my daughter was partially responsible as she had her young baby with her and was not staying close enough to her. There was also a section of uneven payment but anyway that is bridge under the water. She received stitches in her hand. She was badly bruised but nothing else was hurt that required treatment. She was transferred to a hospital. Eventually I had to pay over $400 for the ambulance as no party would cover it. She was not admitted but sent back to AL with further visits to a hand specialist.
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Teddy2019 Dec 2019
Why did Medicare not pay? In all the responses I've received, payment for services has seemed to be all over the place! Yes, they pay in full, to no, they pay nothing. Seems to me, Medicare should be the same everywhere. So it has left me confused.
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Ambulance rides aren’t free. At least I don’t think so. We always paid a fee.
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I assume they would bill your mother, not you. You or your uncle are not personally responsible for the payment.
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Riverdale Dec 2019
I meant to say I paid on behalf of my mother with money from her account as she is not able to pay any expenses due to cognitive issues.
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My friend who is a nurse told me if there isn’t anyone to take a patient home they put them in a cab. I guess it all depends on the circumstances.
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Beatty Jun 2020
If hospital staff help into cab & pt can get out independantly, no probs. Or if staff at AL help at other end but I think MC residents would need an escorted ride.

Someone I know had their Grandma left in a wheelchair outside the hospital & told a taxi was called. Except they forgot. Midnight - winter too. She had to yell to a passing 'youth' (as she called him) to get help. Made the news.
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My father lives in AL and goes to the ER often. It is not feasible for me to retrieve him when he does so they hired a medical transport each and every time to return him to AL. It is self pay at approximately $60 a trip.
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JoAnn29 Dec 2019
That is cheap.
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No they are not obligated to take the person home. HOWEVER, in nursing I cannot recall discharging anyone to the streets unless they were homeless and Social Services had tried to get them into safe shelter and they refused. We had cab vouchers typically, and unless the person lived in another city far away we would supply cab service. Typically we would have cabbed home your Mom or Hospital Van would have taken her home. If the Ambulance took her home, yes, the insurance would have been unlikely to cover an ambulance ride, which goes for 1,000s of dollars, without a need for same.
So cab, rideshare, hospital van, etc would be some of the ways your Mom would have got home. In my brother's case there is a van that is part of the services in his assisted living. Rides on scheduled basis to hospital and doctor, to KMart and to Shopping Centers and such are free, and van ride needed to someplace other (say you want to go to the post office can be as high as about 26.00 added to your bill. A cab in his town would typically be about 15.00 each way, so not too out of line. There is also a van service called "Sunline" for the disabled in his city, free to those who qualify.
It's a good question to run by her facility now. Would they pick her up for a fee? Hospitals charge by hours of stay so they won't keep someone longer than they need to. They charge under observation, after ER time is up. Then usually goes to admission.
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Medicare & Blue Cross secondary insurance pays for all ambulance rides my mother takes; her copay, however, is $100 per round-trip incident. So.......each time she goes to the ER by ambulance, she is returned to the Memory Care AL she lives in by ambulance as well. The return trip is billed as 'non emergent'.
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Please consider that it is time for hospice care for Mom. Hospice evaluation is free and covered in most cases by Medicare or Medicaid. She doesn't necessarily need to go to the hospital after every fall at this point. Hospice can be initiated for a variety of reasons; in my Mother's case, it was her weight loss which initiated the extra layer of care. She was under hospice for two years before she passed away, so it is NOT only for direly end of life care. You should be called with every fall, and you can make the decision whether or not transportation to a hospital is needed. Are you the Medical Power of Attorney? Do you know her last wishes? I know these are difficult issues to consider, but worthy of some thought. Virtual hug from Denver. Gretchen
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lealonnie1 Dec 2019
My mother has fallen 40x in Assisted Living and now Memory Care; she is not a candidate for hospice, not by a long shot! This is not necessarily sound advice you're giving the OP; just b/c a person falls doesn't make them ready for hospice care! A resident needs to be medically determined to have 6 months or less to live before hospice is called in.

When a resident in AL falls, the nurse makes the determination whether she should go to the hospital; when they hit their head, it's the norm to be sent to the hospital. Otherwise, if their vitals are normal and there is no complaints of pain or visible cuts, the POA is called and that's about it.
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I expect the hospital asked your uncle to take your mother home to the facility because it was nicer for your mother - wouldn't you rather ride in a comfortable car with your brother than bounce about in draughty medical transport being manhandled by strangers in uniform?

I should have thought your mother's insurance ought to accept the claim for the ambulance ride *to* the hospital as long as there was well-documented justification for getting her checked out, and a bang on the head should suffice. But see what it says in the terms-and-conditions.

Perhaps the thing to do is work out a protocol with your mother's facility about what is to happen in future should this or similar situations arise again. Don't expect it to work perfectly, but it will help if people have instructions to follow.

I'm a little surprised that nobody from the facility accompanied her. Is that standard practice?
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First all facilities will send a resident to the hospital when the head is involved in a fall. If she was taken by ambulance as an emergency, Medicare will pay for that. They don't pay for transporting for Dr. appts or returning from an ER. The LTC would not except us bringing Mom back after an ER visit. They said she needed to be transported by ambulance. Then the hospital wouldn't take her back because she had been discharged. It was going to take an hr for a transport from a town not 20 min away. This all happened at 11pm. The LTC eventually called me and said they got permission to let us bring Mom back.

I agree, before she is sent out request that u be called. In 4 months my Mom fell 4x at the AL and everytime they called me aft she was taken. She broke nothing. So I told them I was to be called and I would determine if she should go by the info they gave me. Of course she is going to be in some pain (and for someone suffering from Dementia it always seems worse). Aren't u when u fall. I told them to let her get thru the pain and then evaluate. In the next 4 months she was there no ER visit.

In those 4 ER visits Mom was not charged. I don't think ur Mom should have been either. Even though you have paid the bill, I would wonder how the ride was billed. If they say transport I would question that. It was an emergency especially if the head was involved. My Mom did have a balance due but ambulance services in my town are paid by our taxes. So they can only receive what Medicare pays. The balance has to be washed off.
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NeedHelpWithMom Dec 2019
That’s great that your mom did not have to pay. We have always been billed for ambulances. My mom hit her head and still paid.
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Ambulance rides are not free. My mother got a bill for 250.00 to take her from her home to the hospital. She also got a bill for 150.00 when the ambulance came out but DID NOT take her to the hospital because it was a PANIC ATTACK. My mother called and bitched and screamed about the ambulance bills and they told her she didn’t have to pay. Just act like a lunatic and you don’t have to pay.
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mally1 Dec 2019
Next time she'll act like a lunatic!
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Medicare actually does pay for return ambulance rides back to the facility after the patient has gone to the hospital for Medicare covered services. It’s covered by medicare part B.
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My brother had mom taken to hospital for chest xray and assumed she would get a covid test and be admitted. AL here in Atlanta sent her by ambulance. At 1 this morning nurse called me they have discharged her and my brother (POA) couldn’t come pick her up cause he’s in Dallas. He doesn’t tell me anything. So I text him what’s going on? He said don’t go over there he was sending the cops for dumping her. So I took my sleeping pill and didn’t go. At 2 in the morning hospital calls me again - where are you? I said my brother told me he was handling it - he is the POA. So by 3 am I find out hospital sent her back to AL by ambulance and they were ugly about it. Am I obligated to get my mom from ER at 2 in the morning on the other side of town and have to be out driving by myself in the wee hours? Why didn’t the AL arrange the return? They’ve made it clear to me that she is their responsibility and what they say goes. I haven’t even seen my mom from a window since February due to covid and they expect me to have contact with and transport her?
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Beatty Jun 2020
Crazy. I am angry for you.
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We have a different insurance/membership where I live, but if no family & taxi deemed inappropriate our hospitals use a non-emergency ambulance transport vechicle. (I've heard the term Ambulette?) They may charge for this.
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With my Mom, we took her back to the facility and they refused to take her. She was to come back by transport that the hospital discharge person was to set up. We were not told at the hosoital she had to go back by transport. When we returned, we were not allowed back into the ER but they would help with a transport that was going to take an hour. It was 11pm then. The RN at the facility took pity on us and called her boss and we were allowed to take her back. I learned my lesson.

So my answer is, the hospital arranges for transportation. Mom being on Medicaid, I guess they would have paid.
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