You can need an ambulance before you have time to understand who will receive the bill. Someone says your parent must be moved. A dispatcher is calling. The stretcher is coming through the door.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
Pause long enough to ask one question: Did the hospice arrange this ride?
Under the Medicare hospice benefit, ambulance transportation connected to the terminal illness and related conditions is generally handled differently from an ordinary ambulance claim. Medicare says hospital, emergency department and ambulance services are not separately covered for that illness unless the hospice arranges them. The federal hospice rules also place services needed for palliation and management of the terminal illness inside the hospice plan of care.
This does not mean every ambulance trip is automatically paid by the hospice. It means the arrangement matters. A ride ordered through the hospice, entered in the plan and sent to a destination the hospice has approved is easier to place than a ride the family orders on its own.
Ask who is making the arrangement
Do not settle for, “The nurse knows,” or, “The facility is expecting you.” Ask for the name of the organization arranging the ambulance and the name of the person who authorized it.
You can say: “Is this transportation being arranged under the hospice plan of care? Which company are you sending, and who will that company bill?”
Write down the answer. Include the hospice staff member’s name, the ambulance company and the destination. If someone gives you a confirmation or trip number, keep it with the hospice papers.
If a hospital, facility or private caregiver is arranging the ride instead, call the hospice before the ambulance leaves when there is time to do so. Ask whether the hospice agrees with the transfer and whether it will take responsibility for the transportation charge.
Separate a hospice-related ride from an unrelated ride
Medicare leaves ordinary coverage available for care that is completely unrelated to the terminal illness and related conditions. The hospice decides what it considers related for purposes of its benefit responsibilities. You do not need to make that determination yourself.
Ask the hospice to state its position plainly: “Do you consider the reason for this ride related to the hospice diagnosis or a related condition?” Then ask what that answer means for billing.
If the hospice says the ride is unrelated, ask which coverage information the ambulance company should use. If the person has a Medicare Advantage plan, ask whether the plan must be contacted for unrelated transportation. Do not assume that showing a Medicare card settles the question.
Confirm the destination before the wheels move
The destination can change who is responsible for the charge. The hospice may have arrangements with particular hospitals, inpatient hospice units or other facilities. A family preference does not necessarily create a hospice obligation to pay for transportation to that location.
Ask these questions:
“What is the exact destination?”
“Has that location accepted the patient?”
“Is the destination under arrangement with the hospice?”
“Has the hospice approved both the ride and the receiving location?”
“If we choose a different location, who pays for the ambulance?”
In west St. Louis County, two facilities can both sound nearby while producing different mileage, routing and contract questions. Use the facility’s full name and street address. Do not rely on a health system name alone.
Ask about both directions
A covered trip out does not answer the question of how your parent will return home. If the transfer is for short-term inpatient hospice care or respite care, ask whether return transportation is expected and who will arrange it.
Ask separately about:
The ride from home to the facility.
The ride between facilities, if one is anticipated.
The ride from the facility back home.
Any waiting time or second crew that the transportation company says may be needed.
Do not treat “transportation is covered” as a complete answer. Ask which legs are covered and whether each one must be arranged in advance by the hospice.
Do not let urgency erase the billing question
If you believe there is an immediate threat to life or safety, call emergency services. You do not have to delay that call while sorting out payment.
When there is time to call the hospice first, use its round-the-clock number. Tell the person answering that transportation is being considered and ask for the on-call nurse. You are not asking the family to interpret what is happening. You are asking the hospice to decide what response it is arranging under the plan of care.
If someone tells you to call emergency services yourself, ask the hospice to record that instruction. Ask whether the hospice will contact the ambulance company or receiving hospital. A direction to call is not always the same thing as an arrangement for billing.
Before agreeing to private payment
An ambulance crew may ask for signatures while attention is on the move. Read the heading above every signature line. Ask whether the form acknowledges transport, assigns insurance benefits or accepts personal financial responsibility.
If the company says the family must pay, ask:
“Has the claim been presented to the hospice?”
“What did the hospice say was not covered?”
“Is the charge for the whole ride or for a particular service?”
“Can you give me the billing decision in writing before I agree to pay?”
Do not promise payment merely to keep the paperwork moving. If the ride has already occurred, send the bill to the hospice and ask for a written explanation of whether the transportation was related, whether it was arranged and why the family is being charged.
Put one transport note in the hospice binder
Before a late-night call comes, place a single page near the hospice phone number. Write down the hospice’s preferred ambulance process, any named transportation company, approved receiving locations and the person to call about billing.
Add this sentence in large print: “Call hospice before arranging transportation when there is time.”
The quiet work here is not predicting whether an ambulance will be needed. It is making sure that, if one comes, you know who ordered it, where it is going and who has agreed to pay for it.
Source basis: Medicare hospice coverage guidance, the CMS Medicare Benefit Policy Manual and the federal hospice requirements at 42 C.F.R. Part 418 concerning the plan of care and covered hospice services. These materials are collected on the Sources page.