No acknowledgement that OF COURSE care coordination saves money. It just doesn’t save money for doctors. If my sister didn’t have to keep a list of all Mom’s medicines, and if she didn’t have to explain Mom’s health situation every time Mom went to the doctor, and if she didn’t have to keep calling around to all Mom’s specialists every time Mom had a health issue, then she would have more time to earn money designing houses. But that’s invisible to the doctors.
@TempeMom, yikes. No experience and saying it very sincerely … Good luck with that.
@CF … yeah, family blood, sweat and tears are a “free” resource don’t 'cha know…
So does anyone have any success stories or tips for fighting with Medicare for an ambulance trip? Once again, the AL place determined at 2:30 AM that Mom HAD to go to the hospital, and the hospital didn’t check her in after giving her the IV and many tests, but sent her back to the AL place (how she got there I don’t know). Medicare refused to pay, just like last year. I never won the appeals last year (didn’t try hard enough), but I do need to appeal harder this time. It isn’t like she had a choice or a voice so I need to fight it. $1200 for a 2 minute ride (the AL place is 2 blocks from the hospital) I know that they spent time with her before and am not arguing the cost. I just wondered if anyone has tips to get medicare to pay.
On the ambulance ride, we fought several of those that were disallowed, no luck with Medicare, but the ambulance companies did reduce our rate to a cash price, $250-$450.
Can’t say I understand the ambulance fine points, but I see this:
"Non-emergency ambulance transportation
You may be able to get non-emergency ambulance transportation if such transportation is needed to or diagnose your health condition and the use of any other transportation method could endanger your health.
In some cases, Medicare may cover limited, medically necessary, non-emergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is necessary due to your medical condition. Even though a situation isn’t an emergency, ambulance transportation may be medically necessary to get you to a hospital or other health facility."
How does Medicare expect them to get to a hospital?
My dad was never able to get an ambulance covered for my mom. She was totally bedridden and could not get into a car. Took six guys to get her down the back ramp and into the ambulance. $600 each way. Medicare wouldn’t pay for a doctor to come to her, either. It was terribly humiliating for her.
The AL kept calling an ambulance to the ER for FIL, one time they called to report he was on his way, I told them in no uncertain terms NOT to call any more ambulances, but to call me.
I had used a wheelchair taxi for MIL and kept the contact info, I called the person, paid her to go to his AL to get his wheelchair from AL, then drive to the hospital, then drive him home. I arranged half a dozen trips to and from the AL & ER for FIL and used a wheelchair taxi every time. The two times the AL sent him, we negotiated that cash price with the ambulance services.
@TempeMom, is there harm at this point of them having 2 houses? Do they have the financial resources? If they are “stuck” and can’t get it together to move, will they allow someone to come in to help?
Thanks guys…they can “afford it” best if they sell their current place, but can probably swing both. They definitely do NOT want out of the contract. They are very excited. I think they see themselves as still pretty vital…that life would be just a little easier without “working” —which I am sure it will. One reason they want to move away is they have a significant amount of rental units in their small town and they are tired tired tired of being the town landlords. They have a “helper” in town to run the units. Not sure I have much confidence in the dude but there is no one directly in their small town that can step in.
The tyranny of the urgent was what we called it. Every need & demand was quite urgent. I think part of that is the fear that they will forget if they don’t handle it whilst it’s top of mind
Sigh. In my case, my mother would call something urgent or crucial or set a time deadline, we’d plan, then she’d thwart. All of us, each in our own ways, have to add filtering and measuring their requests to our tasks. And sometimes, the spine to say no, when that’s what’s more reasonable. Not easy, especially when you want to do right by them.
What is the policy of the AL regarding transporting a pt to the ER ie, what symptoms prompt the transport? Is it time to transfer to an AL that has an in house PA or APRN that can handle UTI’s, dehyrdration, etc? Many ambulance companies have an “ambulette” transfer service that is covered under Medicare. The period of transition between an DNR status and a “hospice” designation is like no man land. I fault the AL facilities that charge a fortune and are not prepared to dx. simple, common things and treat in house. I always had the hospital transfer family members home or to rehab,etc. using an ambulette.
Urgency is an interesting point. My father is downright rude and insistent, even if I’m on the phone or walking out the door about whatever he wants, right now. A reason I am working on moving him back home. He’s not only rude to me, but my kids too.
Tell me, if he uses a walker and a cane, and hasn’t fallen in many weeks (and those falls were really slips and the situations causing them were fixed), and he is with it enough to feed himself, and I commit to visit him daily unless I know someone else will, can he really not live at home?
He was only with me to push him to go to doctors, and have me review his financial state (which we are still trying to fix). Now that he’s gone to the doctors, and had a procedure (not surgery thank goodness), he is going home with daily visits.
We pretty much decided no caregiver outside the family for now as he doesn’t need any medical help on a daily basis nor help eating or drinking. He visited his house for a few days and did well, with daily visits as mentioned.
Good luck! It’s tough as elders lose whatever filter they have and are tougher to be around. It’s especially bad if they are rude to us and especially our kids and servers and strangers. It makes it tough to want to be around them and when they’re upset, sometimes it just makes them louder, angrier and harder to help.
Rhandco, know the phrase, “It takes a village?” No matter the customs in any family, sometimes outsiders can give the breathing room and perspective we need. Not that long ago, were you the poster who was so sure being so fully responsible for him was going to be a burden you willingly took on? And now, you see what many of us have. Apologies, if that wasn’t you.
The outsider may relieve some of the pressure of his demands, can entertain him somewhat, or distract, can certainly take care of some of the tasks- not bathing or feeding, but a sort of companionship. And of course, for you and the siblings, some oversight.
We call it the tyranny of the urgent, FIL and my mother both need(ed) their questions answered immediately, I suspect in part they are afraid if they wait, they will forget!
@rhandco does he need a mental evaluation? Maybe some medication will help him. Sounds like he may have some mental changes in addition to maybe being angry at being so dependent.
MIL didn’t get her new glasses when she received a new prescription despite not seeing out of the old ones, because she didn’t want to spend the money (which they do have the money) - had a coupon for $100 off and grand-dau took her to get new glasses yesterday. Yah! Now have to see a new dentist - she didn’t go back to continue to work on denture fitting, and the dentist was very rude yesterday to grand-dau and her (grand-dau had a 3 year old and newborn with her, and the weather was also cold, like 5 degrees). Why be so rude to a 77 YO and a young mother who has really a lot of demands on her? FIL cannot understand MIL talking w/o her dentures in, and MIL doesn’t want to deal with hearing aids so they are having a hard time communicating back and forth. I guess MIL is also tired of very restrictive diet gumming the food. Dentures were purchased 4 years ago…
Their son that lives the closest tries to help, but he has no W and his GF has cancer re-occurrence (elevated tumor markers, pancreatic cancer) so he is pretty stressed out, and also is 1 hour away. It will be a major chore to establish medical where we are, and they don’t want to leave their home. MIL doesn’t have the strength to give FIL his shower (FIL has weakness from strokes). H has been helping - so maybe they will agree to someone coming in to help FIL with his showers.
@ECmotherx2 , Sorry I thought I’d answered before, Mom’s AL place has an RN 8 hrs a day. She will come back in the night for emergencies, but NONE of them can do an IV. They were pretty sure Mom was dehydrated, but she was also non-responsive. They had no choice but to call the ambulance. Hospice, on the other hand, can do the IV in place, plus when they are in charge, the AL place isn’t responsible for making the call to the ambulance since they call hospice. The AL place DID call me, I couldn’t do anything from 400 miles away, so I just said that I’d rather they left her in her own bed, but their standards and protocols insisted they get her to the hospital.
Since I am here and whining, the AL place has accepted more residents, has a new director that has started a policy that residents have to buy their own depends, lotions and shampoo, AND raised the rent starting in January. With more residents, they don’t seem to have more staff. It took two weeks to get the paperwork for the new plan of care which was that hospice took over. I am never comfortable when they are so busy they overlook details. I’d rather they overlook the paperwork than the person, but still.