Monticello Times Monticello My Generation

www.monticellotimes.com MyGeneration• Thursday, Sept. 12, 2019 Page 3 How Medicare covers ambulance services for seniors your Medicare supplemental policy (if you have one), will need to pay the re- maining 20 percent. If you have a Medicare Advantage Plan, it must cover the same services as original Medicare, and may offer some additional transportation services. You’ll need to check with your plan for details. Dear Savvy Senior, How does Medicare cover ambulance services? About three months ago, I took an ambulance to the hospital emergency room because I rarely drive anymore, and I just received a $1,100 bill from the am- bulance company. Surprised Senior Dear Surprised, This is a Medicare issue that confuses many seniors. Yes, Medicare does cov- ers emergency ambulance services and, in limited cases, non-emergency ambu- lance services too, but only when they’re deemed medically necessary and rea- sonable. So, what does that means? First, it means that your medical condition must be serious enough that you need an ambulance to transport you safely to a hospital or other facil- ity where you receive care that Medicare covers. If a car or taxi could transport you without endangering your health, Medi- care won’t pay. For example, Medicare probably won’t pay for an ambulance to take someone with a simple arm frac- ture to a hospital. But if he or she goes into shock, or is prone to internal bleed- ing, ambulance transport may be medi- cally necessary to ensure the patient’s safety on the way. The details make a difference. Second, the ambulance must take you to the nearest appropriate facility, meaning the closest hospital, critical ac- cess hospital, skilled nursing facility or dialysis facility generally equipped to provide the services your illness or in- jury requires. It also means that the facility must have a physician or physician specialist available to treat your condition. Thus, Medicare may pay for an ambulance to take you to a more distant hospital if, for example, you are seriously burned, and the nearest hospital doesn’t have burn unit. Similarly, if you live in a rural area where the nearest hospital equipped to treat you is a two-hour drive away, Medicare will pay. But if you want an ambulance to take you to a more distant hospital because the doctor you prefer has staff privileges there, expect to pay a greater share of the bill. Medicare will cover the cost of ambulance transport to the nearest appropriate facility and no more. Non-Emergency Situations In limited cases, Medicare will also cover non-emergency ambulance ser- vices if such transportation is needed to treat or diagnose your health condition and the use of any other transportation method could endanger your health. Not having another means of transpor- tation is not suffi cient for Medicare to pay for services. Some examples here are if you need transportation to get dialysis or if you are staying in a skilled nursing facility and require medical care. In these cas- es, a doctor’s order may be required to prove that use of an ambulance is medi- cally necessary. Ambulance Costs The cost for ambulance services can vary from several hundred to several thousand dollars depending on where you live and how far you’re transported. Under original Medicare, Part B pays 80 percent of the Medicare-approved amounts for ambulance rides. You, or How to Appeal If an ambulance company bills you for services after Medicare denies pay- ment, but you think the ride was medi- cally necessary, you can appeal (see Medicare.gov/claims-appeals). Often, a lack of information about a person’s condition or need for services leads to denials. If you need some help contact your State Health Insurance Assistance Pro- gram (SHIP), which has counselors that can help you fi le an appeal for free. To locate your local SHIP, visit ShiptaCen- ter.org or call 877-839-2675. For more information on this topic, call Medicare at 800-633-4227 and ask them to mail you a copy of the “Medi- care Coverage of Ambulance Services” booklet, or you can see it online at Medicare.gov/Pubs/pdf/11021-Medi- care-Coverage-of-Ambulance-Services. pdf. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. Looking to downsize? Looking for one level living? Snow & Lawn care provided - Low HOA! Slab on grade & Full Basement Villas available PLEASE SCHEDULE YOUR EYE EXAM AT PEARLEVISIONMAPLEGROVE.COM* OR CALL 763-420-5112 13195 Weaver Lake Rd., Maple Grove, MN Locally & Family Owned & Operated *Eye exams available by Doctors of Optometry at Pearle Vision Maple Grove Call The Strobl Group today at: 952.239.9200 Visit us during the Parade of Homes, Open: Thursday – Sunday 12-6 p.m. Prices Ranging from $285K - $400K 40% OFF LENSES WITH FRAME PURCHASE Valid only at Maple Grove Pearle Vision Must present this ad at time of purchase. Frame purchase required. Valid prescription required. Excludes certain frames including Ray-Ban and Oakley. Cannot be combined or used in conjunction with any vision care, insurance beneﬁts or plans, any store offer or discount. Savings applied to lenses. Not valid on previous purchases, readers or non-prescription sunglasses. Some restrictions may apply. See store for details. Valid at MapleGrove location only. Promo code: OMGRPress_0919

Monticello Times Monticello My Generation | Page 3