Dan Golden is not the first person to dispute with Medicare over an ambulance bill. No doubt, many people have shared his frustration.
The federal program for Americans age 65 and older denied payment for an ambulance transport between Modesto and Oakdale for his father Oct. 10. The ambulance company, Pro Transport-1, has agreed not to collect the $1,800 bill from Golden’s 85-year-old mother of Oakdale while they appeal, he said. His father, Robert Golden, died in February.
Medicare denied payment because a basic life support ambulance took Robert Golden from Doctors Medical Center to the skilled nursing unit at Oak Valley Hospital. In Medicare’s opinion, another level of transport, sometimes called a gurney van, was appropriate.
Dan Golden said he understood the van service was not available. He argues his 86-year-old father needed attention during the ride to Oakdale. The man had a broken a vertebrae on the spine, was on strong pain medication and could not walk or sit up.
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Golden said he has spent hours and hours on the phone with Medicare trying to resolve the billing issue. He will return to Bangkok this weekend after spending five months here tending to his parents’ affairs.
“My frustration level is beyond anything I ever experienced,” he said. “My mom is 85 and she can’t deal with this. It seems like it’s a real disservice to the patient.”
His mother is on a restricted income and is unable to pay, he said.
Golden has received some guidance from the Health Insurance Counseling and Advocacy Program of Stanislaus County. He has started an appeal process that can take months or an entire year.
As he goes through the different steps, Golden may eventually have an appeal hearing via telephone with an administrative law judge. The three-way connection could include a judge on the East Coast, Golden in Bangkok and a counselor at the HICAP office in Modesto.
It seems, however, the issue could be settled without going to that trouble.
A Medicare spokesman in San Francisco took some information on the case and will work on getting a response from a Medicare contractor.
Frank Dotson, a HICAP counselor who has assisted Golden, said Medicare often does not pay for ambulance rides between a hospital and nursing home. The program does not believe that life-support transports are necessary for patients who have recovered well enough to leave the hospital, he said.
Golden will have to show that his father needed nursing assistance in the ambulance, Dotson said. He has seen Medicare pay less than half the amount on ambulance company billing statements, and the company disregards the rest.
Those appealing a Medicare decision to deny payment usually need to present additional information at hearing than what was considered before, Dotson said. A nurse or doctor who was involved with the patient’s care is a possible source of information, he said.
At any given time, the local HICAP office is helping three or four Medicare recipients with ambulance billing issues. Sometimes, Medicare denies the claim if the call was not considered an emergency.
For those needing transportation upon release from the hospital, Dotson advised not to rely solely on hospital staff’s opinion on whether the transportation is covered.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or (209) 578-2321.