Dad back at Assisted Living Facility after 911 trip to Hospital ER in middle of night. Have not received any bills yet, but with transport could be quite high. He was not admitted, total time there about 6+ hours. He is 93 has history of very frequent chronic UTI's most antibiotics are no longer effective after many years of fighting UTI's, so it's just a matter of time now, and why he's on Hospice. He was transported to the Hospital because of chest pains but after tests Hospital found no issues. Assisted Living Facility acknowledged mistake but stated "accidents do happen" so not getting warm fuzzy that they will pick up the tab for their mistake. Do I have any recourse? Thanks..!
There is always a RN on call 24/7 and she can make the visit to determine if the patient needs to go to the ER or she can give permission over the phone and call the ambulance company that that particular hospice has a contract with. In the case of something like a serious injury, or other medical emergency the RN can give permission over the phone to go but he/she should go to the hospital and be responsible for determining what level of care the patient should receive.
The POA must also be informed and be given the option to decide how much treatment is given. If the hospice does not agree the patient will be discharged while the patient is treated but can be readmitted when that phase has passed.
Hospice usually has a contract with an ambulance service to transport patients for certain fee. If the patient is discharged from hospice then Medicare/Medicaid or private insurance will pick up the fee. If patient has none of these it becomes the patient's responsibility unless the POA signs as guarantor.
My experience has been that hospice can be very flexible in these cases but they don't usually approve a stay in hospital of more than five days. The best course is to contact the hospice office and they will be able to say what their usual policy is.
It is always best to be proactive rather than wait for the bills to come in and possibly acrue late fees etc.
Clearly in this case the facility is at fault for not calling hospice before transporting the patient but people panic and this is frequent occurrence.
From Medicare....
"If you need to get inpatient care at a hospital, your hospice provider must make the arrangements. The cost of your inpatient hospital care is covered by your hospice benefit, but paid to your hospice provider. They have a contract with the hospital and they work out the payment between them. However, if you go to the hospital and your hospice provider didn’t make the arrangements, you might be responsible for the entire cost of your hospital care."
https://www.medicare.gov/what-medicare-covers/part-a/how-hospice-works.html
Even Urinary Tract Infections are treated, otherwise the elder would be having nightmares, pain, hallucinations, etc.
What insurance does not pay, Ambulance company may and probably will come after you for any part not paid.
How frustrating. I take it YOU weren't called??
First off, be super kind to whomever you speak with. Keep records of the people you talk to, what they say, what you say. Nothing to be gained by coming off angry from the get-go (I don't know you, so I have no reason to think you would, but long experience has taught me that kindness towards the "billing dept" goes a long way)
But I can't see how YOU would be responsible for the transport.
I don't think that it's going to be difficult to arrange with hospice that retroactively, they remove him from that service for the time of transport.
Call the hospice admins and ask what they advise in a situation like this.
The only time Medicare rejected a 911 bill was when mom fell and wasn't transported- $250 to pick her up off the floor