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Do you know if the nursing home assists with sending the claims through Medicare to cross over to the secondary, or do you give the insurance info to the transportation company and THEY submit the claims?
We did not give any insurance info to the the transportation companies. I did, at one point, call one of the transportation companies and asked about a copy of the ambulance report (my dad got that standard letter from his secondary asking for more information about a claim - I get those occasionally from my ins. company too) and the company told me that was not necessary - that the form we received was just a "beneficiary copy" and everything gets handled between medicare, the secondary, and the transportation company.
I'm sorry to say, but barely, if any Medicare nor Medicare Advantage programs cover transport.
The transport that my dad was taking before he was able to ride with me while I took him to his medical appointments, was minimal ($5.00 both ways).
Depending what State you live in and the Medivan service you are using, that could make the difference and it might help if you made some calls to see if there are Medi-taxis that the VA provide to take him the short distance.
In addition, if your dad is on Medicare and has what is considered a "secondary policy", that is considered his Medicare Advantage policy and they take care of all Medicare payments, often paying more than Medicare would. However, they do not pay for transport in most states. You may want to check into this in the state you live in.
BTW..VA benefits/insurance are not considered actual insurance. They are considered a benefit for VA members. However, whatever isn't paid for by the VA CAN and should be sent to his Medicare Advantage carrier.
You can call his carrier and they can give you further info. Hope this helps.
Never heard of secondaries paying for something that isn't covered by Medicare.
One of the reasons we bought a wheelchair van - so that if we need to get dad to a doctor appointment, we can.
Since he can't transfer, we've had numerous facilities mad at us that they have to then use a hoyer (or physically move him themselves) - instead of him coming in on a stretcher.
I always reply, we can't afford the $500 in ambulance transportation for a non-emergent doctor's appointment.
The hosptials/outpatient suregery centers are always quite flippant "well - most of our patients come in by stretcher - that's covered!!"
No. It's not.
MEDICAID seems to have some luck with that - but those people also likely qualify for reduced transportation programs targeted to the elderly/poor (our community has a handicapped bus that is very affordable - $1 per ride, however the waiting list is like 2 years long, and my father doesn't qualify because he can't get himself to the end of the driveway without assistance)
Most ALs have some sort of shuttle. Often Nursing Homes will also have a shuttle and then bill for the service they're providing. Since NH are quite expensive, I wouldn't expect their trasportation to be particularly affordable.
Some secondary insurances to Medicare are private plans that are part of retiree benefits. This is actually quite common. And these private plans often cover more than Medicare alone will cover.
The problem my friend has is that she needs some sort of assistance transporting her husband because he just has too many medical needs right now. Too many tubes and tanks..... So a taxi or even the senior transport services (which do exist here) would not be enough assistance at the moment.
So, in your experience do these charges go to insurance at your nursing home, or are the patients paying up front?
I can't imagine Medicaid patients have the money to pay for this. What do they do?
I think it depends on the plan/supplemental. The nursing home I work in sends Medicaid people out of facility on medical transport all the time, so Medicaid must pay something. My mom had a Medicare Advantage plan and they are notoriously stingy. She used to pay $500 for an ambulance ride across the street from her ALF, now that I switched her to traditional with a supplemental it is all paid for.
If your mom recently changed insurance, make sure they have up to date info. Also make sure they coded everything right. I had a colonoscopy due to a chronic problem I was having, and my insurance denied payment simply because the doctor coded it using a "preventative" versus diagnostic medical code. I had to call her office and tell them to re-send it with the right code.
Unfortunately, Medicare won't pay for transport, as I've checked into this also for my dad.
In addition, nursing facilitites, at least the ones in the state we live in, won't assist in sending transport claims to Medicare.
From the best of my knowledge, Medicare doesn't cover transport fees, which I find ridiculous as they should as the fees are more than "ginormous"!!
Medicare will cover ambulance transport that is medically necessary (i.e. an emergency).
So if your loved one has chest pains, and you call the ambulance and the hospital accepts the patient as being in an emergency... ambulance covered.
If however your non-ambulatory loved one has a routine doctor's appointment with their cardiac doctor - nope. Medicare doesn't cover it.
Just like my employer-provided-health insurance doesn't cover the cost of a taxi for me to get to the doctor, or the cost of my private vehicle (mileage), etc..
Medicare is no different than regular health insurance for the under 65 set, it's just nearly universal and relatively affordable.
There certainly seems to be a gap as to what services seniors (at least some seniors) need, and what medicare routinely provides ... what the answer is to that exactly I'm not sure.
I am however fairly certain that in the poisonous political climate we currently have in this country, expanded services for the elderly are never going to have a chance.
Medicare is no different than regular health insurance for the under 65 set, it's just nearly universal and relatively affordable.
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It is interesting to me to hear people's responses. My father's transport from rehab to the hospital/clinic for appointments was covered by his insurance when he was in acute rehab. He had Medicare primary and a private employee plan secondary. It certainly doesn't surprise me that Medicare doesn't pay. But I thought there was a chance they might pay when you are a short term rehab patient vs a chronic Nursing Home patient.
I would assume his private employee secondary paid?
Dad has a very good medigap (secondary) in addition to medicare (primary), but his medigap does not cover something if medicare rejects it. (but they cover 100% the remainder for anything medicare does cover)
So for us, finding non-medical transport (in our case - a wheel chair van) was a necessity.
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