My mother fell from her wheelchair to the floor on her
face. The nursing facility sent her to the Emergency Room for x-rays, etc.
I just received a letter from the Ambulance Service stating that Medicare denied the claim.
Who is responsible for paying the costs?
They do, as a courtesy and routine procedure provide insurance information so that the ambulance company can bill the insurance properly.
When a claim is denied, someone may have used the wrong codes for treatment and diagnosis, and necessity for the ambulance. May require an explanation by treating physicians.
Either the SNF admin or the ER doctor (admin) can provide better information to the insurance company (medicare) to assist in an appeal. You can mail the insurance cards to the ambulance company. You can request an appeal, but the reasoning needs to come from the doctors. So call the billing office of the hospital so they can provide info to the ambulance company.
You will see the reason for the denial on the explanation of benefits. It may be that the charges are not covered at all. Read your EOB, call medicare to find out under what circumstances the charges are covered. Sometimes, the EOB will state if you did not know, you might not have to pay some charges.
If the charges are correct, negotiate with the ambulance company.
Now he is on on Medicaid and he does not pay. He has no money at all. As long as he doesn’t go over the $2000 amount in his account, Medicaid pays.
Hope that helps.
I turned around and took the letter and discussed it with the Director of Nursing and she said the ambulance co. should bill through the Nursing Facility. I told her I was told it will need to be appealed and we will have to send in her Doctor's note that she did need to be transported by stretcher. So, at this point, I hope the DON will take care of it. We shall see.