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Old 11-27-2015, 07:15 PM
 
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A friend is a caregiver for her husband, who was recently hospitalized. He was moved to a Nursing Home for some low level rehab. While in the Nursing Home, he still needs to get to some doctor's appointments with the outpatient doctors helping his issues. These docs are at the nearby VA hospital/clinic. The Nursing Home is not a VA facility. It's a short ride away, but the hard part is getting him there safely. He is very frail, uses oxygen, needs a wheelchair and the weather is problematic (snow is starting). He is in his 90's and his wife is in her mid-80's and their kids are ...... not the most helpful.

I remembered that when my father was in rehab years ago and had doctor's appointments a transport van and driver would be called to come to his room, get him to the van, strap down his wheelchair, and get him to his appointment. One of us would go with him.

His health insurance paid for all of these trips. We never saw a bill.

My friend was told that she could either transport her husband herself to his appointment (too much for her), or they could call a Medi-car for her. $80. Pay up front.

Should this be covered by insurance?

Currently, they have both Medicare primary and VA benefits, and then two secondary insurance plans through the wife's employer that are quite good. If Medicare denies a claim, it can be sent to her secondary insurance and they usually will pay.

What is typical?
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Old 11-27-2015, 10:14 PM
 
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From what I can remember my mother had Medicare and a secondary(United Health), we had to pay out of pocket for transports. I remember it was expensive just to go a few miles. This was from the same situation a rehab to a Dr. appt.


But with all the insurances you mentioned, one of them may cover it. Maybe they had to pay up front and get reimbursed.
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Old 11-28-2015, 09:26 AM
 
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Thanks for your input.

It makes sense that Medicare will probably reject it, but perhaps one of the secondaries will cover it. I guess I had hoped that the nursing home would deal with processing the claims, which need to pass through Medicare (and get rejected...) before the secondary insurances will consider them. I'll need to help her figure out how to submit a claim to Medicare for denial and then submit it to her secondaries.

Yes, my friend only has to go 1 mile to the doctor's office.
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Old 11-28-2015, 10:40 AM
 
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Quote:
Originally Posted by sfcambridge View Post
Thanks for your input.

It makes sense that Medicare will probably reject it, but perhaps one of the secondaries will cover it. I guess I had hoped that the nursing home would deal with processing the claims, which need to pass through Medicare (and get rejected...) before the secondary insurances will consider them. I'll need to help her figure out how to submit a claim to Medicare for denial and then submit it to her secondaries.

Yes, my friend only has to go 1 mile to the doctor's office.
It sounds like they are paying some, because I work in nursing homes and I guarantee even a mile on medical transport costs a lot more than $80.00. It's probably a few hundred.
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Old 11-28-2015, 11:09 AM
 
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Originally Posted by ocnjgirl View Post
It sounds like they are paying some, because I work in nursing homes and I guarantee even a mile on medical transport costs a lot more than $80.00. It's probably a few hundred.
Thanks for this.

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?
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Old 11-28-2015, 12:17 PM
 
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80 dollars isn't unreasonable. You have to pay out-of-pocket for medical transportation. I used Yellow cab's wheelchair taxi. It cost about 28 dollars before tip for a ride to the orthopedic specialist 8 miles away. The downside is that they won't wait for you, and you have to call them again to pick you up. You may end up waiting several hours for a return ride, depending on the availability from the cab company you initially choose or a competing one you later end up arranging.

The ride to transport her from the hospital to the rehab facility 1/4 mile away cost as much or more than the above taxi ride. A medical transport service will cost you more.
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Old 11-28-2015, 03:10 PM
 
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I don't think Medicare would pay for regular transport to a medical appointment. It wouldn't be categorized as an "emergency."
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Old 11-28-2015, 08:21 PM
 
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My mom's trips have cost anywhere from $150 to $399, ranging from 1.5 miles to 20. Medicare did not pay these, but automatically forwards them to the secondary. We are assuming (hoping) that they will be paid.
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Old 11-28-2015, 08:35 PM
 
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Originally Posted by knowin View Post
Contact your local DAV people. Disabled Vets of America. their rides are free, I believe.
Thanks for this. I will look into it.
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Old 11-28-2015, 08:36 PM
 
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Originally Posted by ChessieMom View Post
My mom's trips have cost anywhere from $150 to $399, ranging from 1.5 miles to 20. Medicare did not pay these, but automatically forwards them to the secondary. We are assuming (hoping) that they will be paid.
Thanks for sharing this.

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?
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