That's just sad. No wonder the US ranks last in health care internationally. And don't get me started on elder care. Edited to add: I just found this online: Emergency ambulance service "Medicare Part B will cover ambulance services when it’s deemed medically necessary, and when an alternate means of transportation could be hazardous to your health. For example, if you’re in shock, unresponsive, or bleeding heavily, Medicare will generally pay to transport you by ambulance. But if you’re dealing with an injured arm or leg that may be broken, that’s not reason enough to warrant an ambulance." Since my husband was bleeding, maybe the ambulance will be paid for. Hope so!
It should be because he banged and cut his head and standing and walking with such can be fatal depending on the situation. I don't think anyone would question that he shouldn't be walking at the time of the transport. It doesn't matter what the ER docs diagnose, what matters is the patient's condition at the time of transport.
Having owned an ambulance company, I agree that the criteria for payment versus non-payment should be the patient's condition at the time of the transport. However, repeatedly, this decision was made on the basis of the final diagnosis. In other words, payment for patients complaining of chest pain and shortness of breath would often be denied if the final diagnosis was something that would not have required ambulance transport. At other times, they would approve the transport charge but deny payment for oxygen, IV, and ECG if it turned out not to be cardiac. Since emergency department personnel would do the same things for someone walking in with chest pain and shortness of breath, I don't know if they fared better with Medicare than EMS services did. Maybe half the time, we could get it paid on appeal, though.
I think that is why the paramedics around here use the rule for medicare if the patient can walk at the time of transport, then they advise getting someone to drive them to the ER. If they insist on transport then the patient or representative signs that they understand medicare may not pay for the transport.
With very short driving times, that might work. We were forty minutes from a hospital, and a lot of people actively having a heart attack could still walk, yet not survive a drive to the hospital without treatment en route. When it comes to injuries (as opposed to illnesses), they were easier to determine.
Is he a Veteran ? If he is he should get the ambulance paid for the first trip to emergency , after that any further transportation would not be paid. I used the VA 3 times over the past 10 years. Don't fall for their line that you have to call for approval. People needing emergency care cannot call a ghost operator working for the government. You have to be prepared to get a lot of excuses from the VA, they love to spend that money on themselves for those high dollar vacations. It is available long as you are aware of the benefits. The bill must be submitted on time or the VA will not pay if late. It does not make the veteran responsible for a bill that is paid for by the VA, that is between the VA and the provider.
. Exactly! That is why in remote rural areas here in the case of a suspected heart attack, family or friends will take off with the patient and meet the ambulance en route and in some cases, the ambulance paramedic after meeting them, will transport them to a helipad or other spot and meet life flight. The idea is to get the patient to a paramedic with equipment IE equipped ambulance as quickly as possible. One thing Zek really impressed on me was a paramedic without equipment is like a carpenter without tools. You may know what needs to be done, but without equipment, it can't happen. In one of our mountainous rural areas where even some of the elderly live in the mountains and the roads are too slow for ambulance travel in the winter, the ambulance meets a snowmobile towing a sled on the main highway.
Doctors and nurses today are over worked and very stressed, especially nurses. I felt so sorry for one when I visited er for supper cold last month, I thanked her and told her how much she was appreciated.
Yeah, they looked really overworked and stressed when I walked up to the nurses station and they were all standing around drinking their Cokes and gabbing with each other.
I guess I am sicker than most of you. I have been to the ER three times as a patient. My rule is if you cannot move, have severe chest pain, or truly feel your life is in danger, call an ambulance or have someone call. If you are severely bleeding, get someone to drive you to the nearest competent ER; do not call an ambulance as you can bleed to death while waiting and ambulance response will be to start an IV which will increase the bleeding by diluting the blood clotting factors. If you encounter someone else in trouble, call 911 if they are nonresponsive. If you are a veteran, always ask them to bill the VA first. As @Thomas Stillhere said, emergency cases are generally covered. If the VA decides not to cover, you can appeal or bill another insurance if you have one. The reverse is not true. The VA will not cover charges that have been billed to another insurer even if they are refused. I don't know about other places, but here we have "transport insurance" that will cover transport to the nearest appropriate facility. Sometimes here, the nearest hospital is 400 miles away and will require helicopter or airplane transport, so the insurance is nice if you spend time outdoors away from things. Transport insurance is generally rather cheap--$100 to $400 annually depending on your situation.
Not every ambulance service operates at the same level, of course, but those operating with paramedics should be able to begin the steps to stabilize someone with myocardial infarction. In the last company that I worked for, as well as the company that I co-owned, our medical director was a cardiologist, in fact, the head of cardiology at a large hospital. We carried 12-lead diagnostic ECG monitors and a wider range of cardiac medications than would be found in most ambulances of that day, and we could send the ECG to our medical director and/or the receiving hospital electronically, for physician direction, so we could provide most of the same care that would be done in the emergency department for the first 15-20 minutes. Some ambulances operate at a basic level and would be unable to do a whole lot more than administer oxygen, which is by itself a significant benefit. Of course, I would disagree with that. If the bleeding is stoppable, which is usually the case if it is external, we would stop the bleeding, after which the IV would serve to replace some of the fluids that were lost, along with sodium chloride, sodium lactate, potassium chloride, and calcium chloride, all of which would have been lost with the blood. Internal bleeding is another matter, as it is not as easily diagnosable and has a very high mortality rate. The emphasis would be on rapid transport with oxygen administered en route. An IV would be started but the fluid would be a drip unless otherwise directed by the receiving physician, with whom we would make contact en route. Again, I can't speak for other ambulance companies, and haven't kept up with standard treatment protocols in the past twenty years.
My opinion was based on a trauma study done by Johns-Hopkins trauma team. They compared "severely" bleeding victims transported by ambulance with those driven immediately from the scene. I believe they had a "distance form the trauma center" requirement as well. They were the ones who made the recommendation. You have much more contact with the field than I do, and they were using Trauma Centers as a reference, not a podunk ER. Apparently, there is a reporting system to ACS that tracks these things and they used the data from that to make the recommendation. They were also analyzing severe bleeding, i.e., gunshots and stabbings mostly that would need blood replacement or component therapy. Sorry, I don't have the link to the study.
If you're a few minutes from the hospital, I'd agree. If you're less than five minutes from the hospital, in nearly every case, you'd be able to drive someone there quicker than they'd arrive by ambulance. But then there's the problem of being seen once you're at the hospital. I've had to intervene a couple of times for people in the waiting room who were clearly in worse shape that the one that we just brought in, and who got a bed immediately because he came by ambulance and we had our own entrance. Oddly enough, hospitals often leave the waiting room triage to non-medically-trained receptionists.