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My 74 year old husband fell down our stairs at home and landed on a tile floor injuring his shoulder. I couldn’t get him off the floor due to his size. I called 911 for an ambulance to transport him to a nearby emergency hospital. They diagnosed him with a dislocated shoulder, treated him and sent him home. What are the chances that Medicare will cover the ambulance transport? Thanks for your feedback. I think I might be responsible for paying an expensive ambulance bill.

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I wasn't involved back in the day, but I do know that mom often used ambulance to get to the hospital to be checked for UTI. She wouldn't drive at night back then, but could have gone anytime during the day. Nope. She would wait and then use ambulance. I chided her for this, as she was taking necessary service from someone else who might *really* need an ambulance. Her response? My medical covers it. Yikes! No way to make her see any sense (or non-sense) in this.

Benefits of having a government based insurance in addition to Medicare. She only had one ambulance ride since moving to MC. It was considered out of network, so I had to pay and submit. I believe most, if not all, was covered, but it isn't clear if BCBS paid all of these or if Medicare covered some pittance. The UTIs, in my opinion, should NOT have been covered, but I'm not the rule-maker! The more recent one was due to a tumble at the facility, they sent her (which I didn't like because she is sent ALONE and has dementia!!!) The nice thing is they do have a local transport and because the facility is close to the hospital, it only cost $10 to have her returned (I was out of phone contact when this all happened, just got home when the call to pick up came. I couldn't run right out and it would be at least 1/2 drive to get there when I could go, so it wouldn't be right to leave her hanging, or worse, wandering...)

I think you have plenty of suggestions regarding need to appeal if denied. Just beware of the time limits and if possible send letters certified/reg receipt so you know someone signed for the letter(s). IF they deny, more than likely you can get a payment option from the ambulance service.
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medicare does pay for ems ambulance and transport ambulance services. You just have to provide the paramedics with your insurance info and they will pass it on to there billing office. My mother goes to the hospital fairly frequently and have never had a problem with payment between coverages with medicare & her supplement. If she has been hospitalized I always get the care coordinator to arrange a transport ambulance to bring her home. Her medicare & supplement have always paid but here is something important to note: my mother can not walk or stand and is immobile. Her doctor's certify this in her medical record thus the insurance pays because of her immobility. So I would think you are ok with just the ems ambulance being covered as long as it gets billed properly but if your loved one can still walk. It will be difficult to get medicare to cover a transport ambulance. Ems ambulance transport runs about 600.00 a trip one way and they do charge for mileage as well. You can also just call your fire dept and work out something with them if by some chance your claim is denied....often times they will do the appeal for you or work out a payment arrangement. Its the fire dept not a mortgage company. They are usually more relaxed about collections. I hope this helped...good luck.
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I do not know where you live, but in the towns around me ambulances collect only based on your ability to pay anyway. They will bill you , but if you cant pay they won't do anything about it. This is not something they advertise as most often insurance does indeed pay.
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Medicare pays for medically necessary transport. As others have posted watch the billing code. This sounds like it was a medically necessary transport by EMS. If you need to appeal Medicare's ruling check out their website. They give the minimum dollar amount that can be appealed, timelines for appealing, and the steps in the process. Do not be afraid to appeal.

If my memory is correct you have 60 days after receiving a denial of payment to appeal. The first step is to simply write a letter explaining why the service was needed and provide any documentation that advances your cause. I believe Medicare has 90 days to review your appeal.

Step two is writing a letter and providing the documentation to help your case to an independent Review board. This takes place if you do not win tat the first level. Again I believe you have 60 days to appeal and they have 90 days to rule.

Step three is to write a letter and provide documentation this time to an administrative law judge. They will review medicare's ruling. Again I believe there is the same 60-90 day window.

If it takes this long do not be surprised to receive calls from collection agencies. Just tell them that you are appealing Medicare's ruling and they will back off. Also I strongly encourage you to reach out to your senator or congressmen for assistance with the government agency. Because my family did not have to appeal the administrative law judge ruling I have forgotten the rest of the steps in the appeal process.

From my experience the problem is not with Medicare but more so with the Hospital/EMS providers. We had to get our family doctor to write a letter and get our senator involved in the case. It was settled in our favor and the EMS provider was required to pay any expenses we incurred.

Best of luck to you. I hope this helps you out.
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Depending on if you have Medicare Supplemental and if so, what plan "letter" you have, it should be covered in full.
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You should have no problem; unless there is some error in the claim submission. If you do not want to wait for Medicare’s payment call the EMS office and ask for a copy of the ambulance run report. It will indicate if the trip was medically necessary.
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Just watch the billing on this one. As long as it was coded as a medical emergency when it was sent to Medicare, it will pay. Errors can be made, however, and you can appeal and quite easily win a reversal.

1)My mom required medical transport via ambulance/laying down from hospital to rehab. Hospital used correct language and Medicare paid. 2) Sodium level became critical and they had to transport her back to hospital. Facility used wrong code and Medicare denied payment. 3)After a few days, hospital sent her back to another rehab and Medicare approved payments.

I appealed the #2 transport denial and used transport #1 and #3 as examples to justify medical necessity. If she was approved for transport when she no longer needed hospitalization, she certainly needed it when she was critical and require hospitalization. Medicare approved the #2 transport and paid it.
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It’s been my experience that Medicare will pay when it’s used to save a life.
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The the big question is what type of Medicare is involved Advantage Programs vary greatly and you would need to read your particular contract to see how much if anything they will pay for ambulance transport and when they will pay. Original or traditional Medicare is a little bit more lenient even today. If the responding EMTs felt that he needed to go to the ER it's very possible they may pay. You can call Medicare or look online to read more about what they will pay but traditional Medicare is a lot more lenient.
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An Advantage Plan may have more restrictions on ambulance payment than traditional Medicare. There is no "network" requirement with traditional Medicare.

Another negative for Advantage Plans.
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Medicare will pay for ambulance transport if the person cannot be safely transported by car or wheelchair van. If someone has been hospitalized the social worker or case manager needs to complete a letter of medical necessity to certify that the person requires ambulance transport. Given your situation, I would suggest contacting the ambulance company and ask to speak to the biller. They should able to advise you regarding coverage. If you are a member of the ambulance company that transported him, if you should receive a bill, you may receive a reduced rate. Your best bet is to call them though.
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I dealt with a similar situation this past November. EMS took my husband from our home to a hospital. Five miles--cost me $1,200.00 because the company was NOT in network. Two weeks later husband was transported from the hospital to a memory care facility. Ten miles--only cost me a small co-pay because the transport company was IN network. We have an Advantage plan.
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Your policy should outline what your financial responsibility. It is always better to pay than to write off an amount since it affects your credit score. When you get the bill, call the phone number on it and make arrangements to pay it off slowly. During the COVID-19 quarantine, they may defer payment until after this pandemic has passed, but you will still have to pay eventually.
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In our area we can pay an annual fee to our rescue crew and they will submit to insurance co. but you never pay a co-payment, Our annual fee is $89. Of course, I don't know if other states offer this or not.
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That’s really nice and reasonably priced. We don’t have that but I like it.
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Original (Traditional) Medicare pays for emergency ambulance transport to nearest hospital that can treat the patient. My dad went to his local ER with chest pains and because he needed bypass surgery, Medicare paid for transport from the ER to another hospital that could deliver services he needed. Also, I had an unfortunate fall several years ago and Medicare fully paid the ambulance fee (broke my nose and arm) for the trip to the local hospital. Don’t know if Medicare Advantage plans pay the fee, however. Seems like they would.
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My mom had a co-pay amount and had to pay the rest. She lives on SS and pays for AL facilities, there is not much left. She told them (wrote a note on bill) she couldn't pay it all at once and was sending 25.00 a month. They keep sending her the bill every month and she paid only 25.00 until the full amount was paid.
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Try calling them and telling them you can’t afford the bill. My mother calls every time and tells them it’s too much money and she can’t afford to pay it. She is 95 years old and they just right off the bill. She hasn’t paid yet for an ambulance.
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mally1 Apr 2020
Wow! Moving my mom to your town; she had just got done paying off an ambulance bill, when she fell again. They wanted to take her in, but called me, and mom and I decided she was alert, oriented, and didn't need to go this time.... no bill. And, no, they didn't negotiate much on the first one. In my experience, it depends on the company, and/or the individual medic.....
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Read your Medicare policy. You may have a copay and it can vary
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They have never paid for my mom, even in emergencies.
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If it's an emergency Medicare will pay. No admittance necessary. At least they always have for my mom. A fall down stairs resulting in an injury for a 74 year old should counts as an emergency.
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Make sure any facility your husband was taken to such as an ER, hospital, or rehab and the ambulance company does the claim right. When the ambulance company coded my mother’s transport the wrong way, we got stuck for a $700 transport, one way. Appealing it didn’t help.
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mally1 Apr 2020
That happens a lot; I know people who are paramedics, and they have leeway as to how they can write the report and code the call.... too often they just don't care about how the patient and their family will pay.
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We were told Medicare will not pay for ambulance transport unless the patient is admitted.

I don't know what actually happened with that incident. I think I heard the patient's husband received a big bill from the ambulance service. The family was advised to appeal the claim with Medicare.

You may also try to negotiate a settlement with the ambulance company.
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"Ambulance services. Medicare Part B (Medical Insurance) covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health."

I think it really has to do with how the ambulance will code the transport.
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mally1 Apr 2020
You're right, JoAnn; paramedics and emts have a lot of leeway in how they write up a report, which determines how an ins co or medicare pays.
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