subject: Medicare Supplement Plans in GA – Don't Get Run Over by an Ambulance Before Reading This [print this page] Medicare Supplement Plans in GA Don't Get Run Over by an Ambulance Before Reading This
Do Medicare Supplement Plans in GA provide for ambulance coverage expenses? Get the facts regarding how every one of the senior Medicare supplement plans in GA provide payments for ambulance services. Here it is not a yes or no, but exact situation answers so you know now, before services are supplied. One senior may have out of pocket expenses while another elderly person has none. What follows is a clear understanding you should know right now.
Ambulance bills are covered under Medicare provisions.
If your Georgia supplement plan refuses to pay remaining unpaid expenses, here is what to do. Protecting your bank account from loss is safeguarded just by understanding the rules.
Medical assistance transport companies provide valuable services for GA elderly people. (Even the senior youngsters between age 65 and age 85) When your health is at risk, and you have a medical emergency, it is quick judgment time. Your transportation by ambulance then becomes a life or death decision.
Throughout Georgia, emergency transporting firms have trained medical staff on board. A senior's needs are already pre-planned making your ride is as comfortable as possible. Some ambulance trips are routine, while others are critical.
When you need an ambulance, who pays?
Jim is a very healthy GA 65+ aged senior. Lo and behold, a new day arises and his heart stops!
Jim loves living in the pleasant picturesque north Georgia mountains. The air is clean high on a mountain top. So clear he often gets to see Atlanta skyline in the far off distance. Life seems simpler in Jim's little town. The lone doctor knows everyone in the small GA town plus their medical history without even reviewing a chart.
Jim loves taking unplanned brisk walks along rarely taken mountain trails with his Golden Retriever, Fetch. Both are muscular and lean. He follows his diet, never using doctor forbidden tobacco. Just one generic supplemental pill faithfully keeps his blood pressure in check as his sole prescribed medication. Returning from an energetic brisk walk, Jim feels sudden blood clenching pressure in his chest. It now flashing throbbing beams faster than a radar gun. Suddenly his left arm is radiating intensive screaming pain. He is having a full blown heart attack.
He calls 911, and within nine minutes gets whisked to the closest hospital to be stabilized. Three days later, Doctor Harvey thinks it is a good plan to move him to a different hospital. There is more equipment in the larger hospital for closely diagnosing damage while monitoring progress.
An ambulance is summoned to get Jim over to the modern hospital. Everything seems fine. Jim is recuperating nicely until he gets the ambulance expense notice.
Medicare and His Georgia Supplement Plan Both Deny the Claim
Jim is unexpectedly looking at $1600 bill for ambulance services. Why would both refuse his claim?
Here Medicare works no different from GA supplement health plans. They are liable to pay claims for treatment that is medically necessary. Medical necessity is a strict requirement before any claim can be considered as eligible for coverage.
Taking Jim from home to hospital following his heart attack is definitely a medical emergency. But going from hospital A to hospital B might not be. It seems Jim's doctor thinks a good idea would be to get Jim care in a larger hospital, yet somehow the old doc failed to write a prescription authorizing the need.
When the ambulance company filed a claim with Medicare it was denied for coverage since it was not considered "an emergency necessity" that an ambulance is used. Because of Medicare's denial, Jim's supplement plan, like other GA supplement plans, is not obligated to pay either.
Was Jim Then Stuck With the Uncovered Remaining Expenses?
No, not necessarily.
It seems the medical transport company also fails to follow written rules. Medicare Publication 11021 specifically outlines the conditions under which they approve and pay for ambulance services. It also provides guidelines for all companies providing transportation services to seniors.
If the ambulance service company has reason to believe that Medicare will not pay the charge, they should ask the patient to sign an ABN form. The Advance Beneficiary Notification (ABN) form notifies patients they will be responsible for paying the bill if Medicare denies the claim. The form needs to get signed BEFORE services are rendered.
If you sign the form and claim, and your coverage is denied, you are responsible all expenses. However by not signing a form, or if the medical provider never provides the written form, this is how you should react.
You might not be liable for the charges. Your Medicare Summary Notice (MSN) clearly explains why coverage expense is being refused. Get out your pen. You have a right to appeal Medicare's initial decision. Now that you feel relieved, get more information here on Georgia Medicare Plans for free.
