How Much does it cost

What does it cost?

Ms. Obtuse recently fell and broke her left hip. Dr. Kildare decided she needed a total hip replacement rather than just a hip pinning. A referral was automatically called to a local acute rehab hospital. She was accepted for rehab by the hospital and transfer was planned for Ms. Obtuse.

On the third day, a Saturday, all paperwork was prepared and Dr.Kildare wrote orders to transfer Ms. Obtuse. When Ms. Obtuse’s son was called to transport her to the rehab hospital, he stated he did not have a car that day and another family member was working therefore also unable to transport. “Just call an ambulance to take her”, the son stated. The staff nurse called an ambulance without knowing Medicare’s guidelines for paying ambulance transportation.

Ms. Obtuse recovered from her surgery and had a successful rehabilitation. Four months later, she received a bill from the ambulance service for $780.00. This was the cost of a three mile, non emergent ambulance trip from the acute care hospital to the acute rehab hospital. At the time of transfer, Ms. Obtuse was able to sit upright in a chair and ambulate a short distance with the aid of a walker. Medicare guidelines state if a person is able to ambulate (even a few steps) and/or sit upright in a chair, ambulance transport is not covered.

You may ask, why Dr. Kildare or the staff nurse did not inform the patient of Medicare guidelines? Doctors and nurses do not know all Medicare or commercial insurance guidelines. Unless they work in an area that requires them to learn more than basic information, they will order what a patient and/or their support system requests. They could also ask why you do not know what your insurer pays for.

What will lack of knowledge about insurance coverage cost you?


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