My cousin had Health Net Insurance and Medicare. I just received a notice from Health Net for the ambulance ride to the hospital and apparently they don't cover any part of the ambulance. I'll call tomorrow to be sure. My various insurance plans always paid a percentage of the ambulance. What has been your experience with insurance and the ambulance bill?
Added: He was working and I think that Health Net pays first. I'm not sure now. He died and so I can't ask him. Health Net should be able to tell me that part. I remember that hospital and doctors' office intakes were always confused.
Thank you, Patty. You got me on the right track. I googled Medicare and ambulance service http://www.medicare.gov/Pubs/pdf/11021.pdf It appears that Medicare decided the trip was not an emergency. The attendant did say that I could transport him but his doctor had said to call 911 and an ambulance. Guess, I'll try to get a statement from the doctor to send to Medicare. The ambulance ride just a little over a mile was over $1000. He was very weak and unable to walk but I suppose the attendants would've helped get him in my car. Sigh! It's hard to think of all the ins and outs in a time of crisis.
I'm anxious about all of his bills. It will take time to get it all worked out.
Thank you Sheila. Veronica. Yes, that does seem ghoulish. I don't know why I put it in. I think it was the equivalent of a nervous laugh. Strange!
Thank you, everyone for your kind responses. I went back and looked at the notice. It was from Medicare contractor saying Medicare wasn't paying anything. Since, Keith was still on his company's payroll, I'm pretty sure his insurance, Health Net, is first one to pay. I haven't received a bill from the ambulance company yet and so I'm going to wait and see what Health Net decides once the ambulance company bills me.
My cousin did think to sign a form giving his bank the OK to pay me on his death, POD, and so I do have some money to pay his extensive bills. I'd never heard of that possibility. He had melanoma and so did have some time to plan. This has been the first glitch in the process. I'm sorry, Felinestroller W.. you've had such difficulty. It's incredible how insensitive some systems are. BTW I like your new name.
May 14, I received a bill from the ambulance company for $67. Insurance did pay the rest. I didn't do anything and it worked out.
I think you have a problem with "medically necessary" medicare says the ambulance was not necessary.. he was not that sick.. so you need the dr to write a letter to say that he was that sick.. and he couldn't sit in a car for X number of minutes.
Oh my gosh that is so sad. I would think the insurance should pay for it. So sorry for your loss.
You have gotten a ton of great advice. Keep in mind that most insurance companies "decline" first if there is ANY question, but many will work with you if you have a doctor's support.
Make sure to write down everyone you speak to... date, time, name and brief summary of the call b/c you will have to repeat this with each new person you speak with about the situation. "Hi, what is your name? Thank you. Last Monday morning I spoke with Susan regarding claim #1234. She let me know that ____ and suggested that I speak with you." Starting a conversation this way with the "next up on the chain" let's the person know that you have been keeping notes and that you are following their process.
When I worked in a chiropractors office we often dealt with medicare declining payments. They deemed most things medically unnecessary. (Essentially the same thing as saying it wasn't an emergency.) The doctors would have to code their bill differently, and resend. When you talk with medicare, see if a letter would help. We often faxed letters from the doctor, describing the need for a service.
I worked with insurance 4 yeas ago, so I understand it could work differently now. This is how medicare and supplemental worked for us. Things can get murky when you are dealing with supplemental insurance. They pick up the remainders of what medicare doesn't monetarily cover. However, they won't pick up services or procedures medicare refuse. (I hope that made sense!!) If medicare is being billed first and they ultimately refuse to pay, Health Net would not pick it up. However, medicare will (if they deem it necessary) pick up things Health Net won't cover. It all depends on the need. It has to be seen as needed, or you are kind of up the creek. The doctor should help you clarify that with medicare. Ultimately, you followed doctor's orders. Most likely, this can be totally rectified with a letter from the doctor, or documentation of orders. That's usually all they need.
I meant to add, that I'm very sorry about your loss. Insurance companies do not allow for grieving time, and it's just awful.
Who pays first? If she is not working Medicare pays first. Health net is secondary. However, if Medicare does not pay, secondary insurance will not pay either. If she is working or husband still works, Heath Net is first, Medicare second.
I would think his demise would serve as some evidence the trip was, in fact, an emergency. (Why "smile," by the way? It seems somewhat ghoulish!)
Sorry for your loss.
M., i am sorry for the loss of your cousin and now having to deal with some of the bills. Since he was working private insurance pays first and then Medicare. Do Health Net not cover ambulance transport period or did they not pay for his because they felt it wasn't medically necessary. If they don't cover, send it in to Medicare. You may have to appeal both sources. Our experience with Medicare was that we had to appeal an ambulance ride to get it covered. You can get documentation from the ambulance co. and the hospital and the doctor who said to call for an ambulance. (You may need to find an emergency or medically necessary reason for the transport --like he needed to have his blood pressure monitored on the way, he needed medication administered on the way, the ER doctors wanted him to have certain medical procedures on the way, or he was too weak to get to a car and you had no way to get him to the car (i don't know if the last one qualifies). Good luck and expect to have to appeal to Medicare.
M., I have no experience in this arena, but just want to send you hugs. I know that having to handle all the details after a death is so hard...
