JustCare

Tag: Ambulance

  • Three steps to prepare for an at-home emergency

    Three steps to prepare for an at-home emergency

    Jancee Dunn reports for the New York Times on how to prepare for an at-home emergency. When the ambulance arrives, in many instances, speed can be life-saving. If you or someone you love has suffered a heart attack or stroke, your brain can suffer irreparably within minutes.

    How to get emergency services at home: Sometimes, you’ll have to call 911. But, sometimes, you’ll be able to contact the ambulance company directly. So, before any emergency arises, contact the hospital you’d want to be admitted to in an emergency to learn which ambulance company you should use to get there, write down the company’s name and phone number and put it in a safe place.

    Keep your costs down: Double-check with your insurer that your health insurance will cover that ambulance.

    Keep in mind that hospital emergency rooms are not equal. Some are far better than others. Make sure you choose an emergency room that will meet your needs.

    If you call 911, let the ambulance company know the hospital you want to be taken to. The ambulance generally will take you to the nearest hospital. But, if you live in a city, there might be several hospitals within a short distance. If so, the ambulance should be able to take you to the hospital of your choice.

    Three steps to prepare for a trip to the ER:

    1. Put together your personal information–your name, birthdate and information about your health, including your blood type, the medications you are taking. Share the document with family and friends.
    2. If you’re home alone, make sure that your personal and health information is easy for a stranger to locate. Tape it to your front door. Enter it on your mobile phone medical ID page. Medical ID information does not require a password to access.
    3. If an ambulance is coming to your home, if possible, unlock the front door so it’s easy to enter.

    Here’s more from Just Care:

  • Unless you have Medicare, surprise ambulance bills are common

    Unless you have Medicare, surprise ambulance bills are common

    Unless you have Medicare, surprise ambulance bills continue to be a serious concern for most Americans, even Americans with health insurance. Often the local ambulance is out of network and comes with a high price tag. If you have Medicare (or Medicaid), thankfully, you should never see a surprise bill of any type.

    Federal law protects people with Medicare and Medicaid against all surprise medical bills. But, no federal law protects anyone else from these bills. The recent federal law that protects working people from surprise bills does not include bills from ground ambulance companies.

    People needing ambulance services are at grave financial risk. More than eight in ten ground ambulance rides are not in network. At the moment, Congress is not addressing surprise ambulance bills. Rather it has established an ambulance advisory committee, which has yet to meet, as Bob Herman explains in Stat News.

    Some suggest that the ambulance rates should be based on Medicare’s rate of around $500. But, ambulance companies argue that rate is too low. Until Congress acts, Congress is subjecting people to unreasonable health care costs and putting them at risk. You cannot easily shop around for ambulance services.

    What can you do to protect yourself against a surprise ambulance bill? The best you can do is find out from your health plan the names and phone numbers of the ambulance services in your network and post that on your fridge. If you need an ambulance and it’s not a dire emergency, you will know who to call.

    Who owns the ambulance companies? Mostly municipalities and local fire departments.  About ten percent of the time, private equity or a Wall Street firm owns the ambulance companies.  Congress did not want to mess with their revenue streams.

    Ten states protect their residents from surprise ambulance bills.  The state laws are limited and protect people only if they have state-regulated insurance. The 100 million people who work for a company that self-insures have no protection against surprise bills. Their insurers will pay something, but the patient is left paying the difference, which was more than $2,000 in one municipality, where the fire department offers ambulance services.

    What can you do if you get a surprise ambulance bill?  You can appeal the ambulance charge, ideally with the help of your Human Resources department. But, the arbitration process in place to settle disputes is protracted and unworkable. 

    Here’s more from Just Care:

  • When will Congress address surprise ambulance bills?

    When will Congress address surprise ambulance bills?

    Surprise medical bills are all too common, leaving millions of Americans with health care costs they did not expect to pay. A couple of years ago, Congress passed legislation to end surprise medical bills for some services, but the ambulance industry was able to keep Congress from protecting Americans from surprise ambulance bills. Fortunately, people with Medicare have protections and generally do not have to worry.

    Congress was resistant to addressing surprise ambulance bills allegedly in deference to municipalities that generate substantial revenue from running ambulance services. Congress also claimed not to have a good handle on the appropriate cost of ambulance services.

    A new report from US PIRG describes the toll that surprise medical bills takes on Americans needing ambulance services. Even in the 10 states that go farther than federal law to protect their insured residents from surprise ambulance bills, anyone working for a large employer with a self-funded ERISA health plan—a very large cohort—does not have protection from their state laws.

    The problem of surprise ambulance bills needs addressing for multiple reasons. For one, we are talking about a large cohort of the population. Some three million Americans with private insurance use ambulance services each year. Who knows how many do not seek critical care for fear of the cost, endangering themselves.

    Second, when people call 911, they have no control over whether the ambulance that comes for them is in their health care provider network. About half the time the ambulances are out of network. Every ambulance affiliated with 911 should be in the insurers’ networks.

    Today, working Americans with health insurance are scared to call 911 in an emergency, for fear of an ambulance arriving that is out of network and receiving a surprise bill that they cannot afford to pay or do not want to add to their list of expenses. The typical out-of-pocket cost is $450, but in some states it is more than $1,000. Millions of Americans at risk.

    What you can do: Talk to your members of Congress about the urgent need to end surprise ambulance bills. In the meantime, find out which ambulance services are in your health plan’s network, and put their numbers in your phone contact list and/or on a list of important contacts in your home. Share it with your loved ones and  health care proxy.

    Here’s more from Just Care:

  • Warning: An air ambulance ride could cost $489,000

    Warning: An air ambulance ride could cost $489,000

    How much could you be charged if you take an air ambulance? For sure, many times what it actually costs. Julie Appleby reports for Kaiser Health News on a man who was charged $489,000 for his air ambulance ride. How do you protect yourself from such insane charges?

    Medicare and other health insurers should cover air ambulances when medically necessary. The question becomes what is medically necessary. Because they cost so much, it is in the corporate insurers’ financial interest to claim that air ambulance rides are not medically necessary.

    Appleby’s story profiles a 32-year old man, Sean Deines, who fell gravely ill while in rural Wyoming. He had a low white blood cell count, which turns out to be acute lymphoblastic leukemia. He needed emergency care, for which he was airlifted to the University of Colorado hospital. His insurer, Blue Cross Blue Shield of North Carolina, through his state health insurance exchange, covered that trip.

    After Deines is stabilized, he and his wife decided to get care at Duke University Medical Center, his in-network hospital in North Carolina, where his family resides. The air ambulance company they contacted, Angel MedFlight, said it would accept payment from his insurer, and he would have no responsibility for the cost.

    Notwithstanding representations from the air ambulance company to the contrary, Deines received a bill for $489,000, About $70,000 of the bill was for ground ambulance services in Denver and Raleigh-Durham. But, Deines’ insurer claimed this transport was medically unnecessary; he could have remained in Denver for 28 days of treatment to put his cancer in remission.

    The air ambulance company tried to get prior authorization from Deines’ Blue Cross plan, but it transported Deines before it had approval. After Blue Cross denied the service, Angel MedFlight appealed, which resulted in a check to Deines from Blue Cross for $72,000, covering a small portion of his services, which Deines forwarded to Angel MedFlight.

    Three months later, Blue Cross demanded its money back, saying it had paid the $72,000 in error. It ended up sending the debt to a collection agency. Angel MedFlight appealed again to an outside independent evaluator who ruled for Blue Cross, claiming that Deines could have stayed at the Colorado hospital.

    What can you do to protect yourself from an air ambulance and ground ambulance bill of this magnitude? Shop around. Recently, I helped a family member get from a hospital in Arkansas to a hospital in New York. The total charge for the air ambulance and the ground ambulances from and to the hospitals was under $20,000, a far cry from $489,000. It’s also a good idea to call your insurer to understand its coverage policy. But, it’s not likely you would know ahead of time whether the insurer would pay for the service or deny coverage on medical necessity grounds.

    NB: As of January 1, 2022, air ambulances must tell you the cost of their services ahead of time. The federal No Surprises Act should protect you from being charged anything more than what your insurance pays a network provider; it should also ensure you are told what your costs might be if your care is denied.

    Here’s more from Just Care:

  • Round up: Emergency care

    Round up: Emergency care

    As you know, health care costs can be sky high. Regardless of what you pay, your health outcomes depend heavily upon the quality of care you receive. Since emergencies are by definition unexpected, it’s important to think about what could be in store for you and to plan ahead for a medical emergency.

    Preparing yourself:

    Making sure Medicare covers your care:

    The importance of a good primary care doctor:

    Your hospital care:

    Thinking about costs:

    And, for the broader picture:

     

  • Why Congress isn’t stopping ambulances from issuing surprise bills?

    Why Congress isn’t stopping ambulances from issuing surprise bills?

    The new federal law banning surprise medical bills does not do as good a job protecting people from unexpected bills as traditional Medicare–which does not allow them at all. It simply keeps out-of-network doctors, hospitals and air ambulances from charging patients directly for services they receive, over which they have little if any control. But, it doesn’t stop out-of-network ground ambulances from charging people a small fortune for their services. Why doesn’t it?

    Of all the surprise bills people receive, ambulance bills are particularly common. By some accounts, more than seven in ten ambulance rides are out of network. And, the average cost to patients for the service is $450. But, even though these costs keep people from calling 911 in a health emergency, members of Congress could not bring themselves to ban out-of-network bills for ambulance services.

    Part of the issue, according to the New York Times, is that federal lawmakers did not want to take on local lawmakers who are often responsible for allowing these ambulance bills. Many ground ambulances are run by municipalities that need the money they receive for out-of-network services, particularly given the economic devastation Covid has wrought.

    High private ambulance charges are common. But, public agencies that provide ambulance services appear to be as bad as private ambulance companies at sending out surprise bills. In a given year, patients owe around $129 million for ambulance services.

    Members of Congress also apparently felt that they did not know enough to regulate ambulance companies. For example, there is little information on what it costs to maintain an ambulance. They did not want to act rashly, perhaps thinking that they would drive ambulance companies out of business.

    Many states that are regulating surprise bills do not yet regulate ambulance services. Shockingly, in Texas, 85 percent of ambulance services are out of network. City-run ambulances do not have contracts with health insurers. In Colorado, private ambulances cannot issue surprise bills; but, they can charge as much as 3.25 times Medicare’s rate for ambulance services. Public ambulances can send out surprise bills, allegedly because the fire chiefs who often provide ambulance services lobbied against having the fire departments’ bills regulated.

    Instead of banning surprise ambulance bills, Congress established a commission to examine and report back information about ground ambulance services and bills. Traditional Medicare pays a regulated rate for ambulance services. It plans to collect more data on ambulance costs and share it.

    Here’s more from Just Care:

  • Plan ahead for a hospital visit: Talk to the people you love about these seven important items

    Plan ahead for a hospital visit: Talk to the people you love about these seven important items

    Few of us think about preparing in advance for a hospital visit, for someone we love, let alone ourselves. But, eventually, most of us will make a visit as a caregiver or a patient. Talking to the people you love about their needs while they are in relatively good health can ease the stress and reduce the costs of these hospital stays, particularly in emergencies. Here are seven important ways to prepare:

    1. Identify someone you trust to serve as your “health care proxy”–someone who can speak for you about your health care wishes if you are unable to speak for yourself. Make sure the person you choose as your proxy knows and talk to the person about the kind of care you want. Ideally, you should complete a an advance directive, which includes a health care proxy document (available for download for free here) and give a copy to your proxy or tell your proxy where to find it. You should give a copy to your doctor as well.  Here’s more information on the importance of a health care proxy.
    2. Ask a family member or someone else you trust to be your health care buddy and agree to accompany you to the hospital and stay with you if you are hospitalized. A second set of eyes and ears can be critical to your well-being.
    3. Make a list of your medications and your doctors. You should keep the list in your phone or your wallet and share the list with your health care proxy and family members.
    4. Decide which ambulance company will be called if needed. Make sure you have the phone number of a Medicare-approved ambulance company on hand or, if you are enrolled in a Medicare Advantage plan, the name and number of an in-network ambulance company. Here are two ways to make sure Medicare covers ambulance services.
    5. Decide which hospital you want to use. If you are not enrolled in traditional Medicare, make sure the hospital is in your network and that it gets a good rating for patient safety. Talk to your doctor about your choice. Here’s more information on choosing a hospital.
    6. Make sure you know what to bring with you to the hospital and what you should leave behind, such as valuables. Here’s a good checklist.
    7. Before you leave the hospital, make sure you have a written discharge plan, along with a phone contact at the hospital, schedule a follow-up appointment, and make a list of any new medications. Here’s a good checklist.

    Here’s more from Just Care:

  • How to protect yourself from surprise medical bills?

    How to protect yourself from surprise medical bills?

    Watch out for huge medical bills if you visit the emergency room and are enrolled in a commercial health plan. They are common, and Kaiser Health News reports that these bills are often permissible. What should be done to end surprise medical bills? Medicare for All, of course. How can you protect yourself from surprise medical bills?

    In today’s commercial health care system, you want to avoid out-of-network emergency care if at all possible. Plan ahead and identify the emergency room in your health plan’s network and the in-network ambulance that will take you there. If not, here’s one example of what can happen: In the Spring of 2017, St. David’s Medical Center charged a teacher $108,951 for his four-day emergency stay after a heart attack. St. David’s, in Austin, Texas, is operated by HCA Healthcare, the nation’s largest for-profit hospital chain. The teacher’s insurance had paid $56,000 for his out-of-network care. But, the hospital billed the teacher for the difference.

    Fortunately, the story got a lot of media attention. And, shortly after Kaiser Health News and NPR reported it, St. David’s  cut its bill down first to $782.29 and then to $332.29. But, what about all the people with exorbitant medical bills that do not get major media attention?

    What’s particularly noteworthy is that the reduced bill does not reflect St. David’s acknowledgement of billing errors on its part. The hospital’s original bill was intentional. Indeed, the hospital claims it “did everything right in this particular situation.” How? The hospital had let the teacher know that he might be able to get a “discount” on his bill based on his income. 

    The issue, of course, is the legitimacy of St. David’s charges. It stretches credulity that the teacher’s four-day stay could have cost the hospital anything close to the amount it billed. The fact that it slashed the additional charge down to a few hundred dollars immediately after it came to public view also suggests the bill should not have been sent.

    But, in this case, the teacher had insurance through his employer’s self-funded health plan. And, according to Kaiser Health News, ERISA, the federal law concerning self-funded health plans, allows hospitals and doctors to charge patients receiving out-of-network care seemingly whatever they please on top of what their employer plan pays. About six in ten people with employer coverage are enrolled in an ERISA plan.

    Surprise hospital bills are pervasive, particularly when people are seeking emergency care. Some states have stepped in to protect their residents from surprise bills in a limited way. But, not enough. And, Congress has yet to address this serious issue. According to Congressman Lloyd Doggett, “This is a nationwide problem, and we need a nationwide solution.” 

    If your health care coverage is not from your employer through a self-funded ERISA plan, you should be protected from some of these exorbitant surprise bills. The Affordable Care Act permits out-of-network hospitals to bill patients only what they would have paid in an in-network hospital. That said, the ACA still allows out of network ambulances, doctors and hospitals to charge patients for whatever their health plans do not pay.

    If you get surprise medical bills, you should appeal to your health plan to pay them. And, if that does not work, contact your Congressman and Senators as well as your local newspaper and Kaiser Health News to report your story. It’s important to keep the pressure on Congress to address this issue.

    No one should be forced into extreme medical debt or bankruptcy because of a medical or hospital bill, or for that matter, a prescription drug bill. Medicare for All would put an end to these bills. Not surprisingly, the majority of Americans support Medicare for All and an ever increasing cohort of Democrats in Congress do as well.

    If you support Medicare for All, please let Congress know. Sign this petition.

    Here’s more from Just Care:

  • Anthem keeps people from getting ER care simply by claiming it may not pay for it

    Anthem keeps people from getting ER care simply by claiming it may not pay for it

    The New York Times has a follow-up story on Anthem, the insurer that unconscionably denied some of its enrollees coverage for emergency care if it did not believe their diagnosis warranted it. According to a new congressional report, Anthem has reversed its policy. Still, Anthem likely has deterred its enrollees from seeking ER care.

    In 2017, Anthem denied coverage for more than 12,000 emergency room visits, stating that they were unnecessary and “avoidable.” However, the patients who appealed Anthem’s denials were successful in most cases. The benefit to Anthem is that most people do not know they can challenge an appeal and that it can be worth it to do so. So, they ended up stuck paying ER bills that they likely should not have had to pay.

    Anthem says it has now changed its policy, limiting its denials for ER visits. And, there is some evidence that it is now approving ER care in most instances. But, there is also a fear that its enrollees are worried about being denied coverage for their ER visits and not seeking ER care when they need it.

    Anthem has been sued by doctors’ groups, who allege that Anthem violated the law with its ER policy since it forced patients to determine whether they needed ER care when they did not know their diagnoses. Let’s get real. People generally do not know whether they are having a heart attack or heartburn.

    Anthem says that it is simply trying to keep its costs down since ER care is so expensive. Of course, the less it spends on care, the more profits it makes. Rather than penalizing patients who think they need ER care because ER costs are so high, Anthem should be arguing for Medicare for all, which would include rational prices for care.

    Congress, for its part, should step in and support Medicare for All. Senators and House members should recognize that commercial insurers are unable or unwilling to rein in excessive and unsustainable provider costs. Instead, they shift responsibility onto their enrollees

    If you support Medicare for all, please sign this petition.

    Here’s more from Just Care:

  • What Medicare covers

    What Medicare covers

    In order to plan for your care as you get older, it is good to know what Medicare covers and what it does not cover. You can then budget for your out-of-pocket costs. Because Medicare generally does not provide full coverage and does not cover some high-cost services, annual out-of-pocket health care costs with Medicare average $5,500. And, if you need to pay for long-term care services, unless you have Medicaid as well as Medicare, your costs will likely be much higher.

    Services Medicare covers: Medicare Part A–which is generally premium-free if you or your spouse paid Medicare taxes–covers hospital, skilled nursing facility, skilled rehabilitation facility, hospice and other inpatient services. Medicare Part B–which has a standard monthly premium of about $134, though people with higher incomes pay more–covers medical services from doctors, therapists and other Medicare-certified health care providers, along with medical equipment and supplies. (To be enrolled in traditional Medicare or a commercial Medicare Advantage plan, you need Medicare Parts A and B.) Medicare Part D–which has a monthly premium that varies depending upon the plan you choose–covers prescription drugs and is optional.

    Note: People who enroll in a commercial Medicare Advantage plan also have Medicare Part C.

    Click on the links below to learn more about Medicare’s benefits and the services it does not cover.

    Keep in mind that some costly services are expressly excluded from Medicare coverage.

    Services Medicare does not cover:

    If you qualify for Medicaid as well as Medicare, Medicaid may cover some of these services.

    Here’s more from Just Care: