EFFINGHAM —
Terry White likes to tell the story about a man in the country who claimed he had chest pains.
“Our crew took him to the hospital. Ten minutes after they got there, he signed himself out of the emergency room and was on his way to a bar,” White said.
But White, owner of Altamont Ambulance Co., has a warning for those who use ambulances for non-emergency means.
“If it’s not an emergency and not medically necessary, Medicare won’t pay for the call,” he said.
White said Medicare is increasingly forcing ambulance providers to screen calls for medical necessity.
“Under the Medicare Act, ambulance services have the responsibility to make sure transports are reasonably necessary,” he said. “The key words are reasonable and necessary. The biggest thing is that people need to know when an ambulance call is appropriate.”
Paramedic David Stankus of Jasper County Ambulance said those with true medical emergencies should not hesitate to call their local ambulance provider.
“Ninety-eight percent of our calls are not a problem,” Stankus said. “But Medicare fraud is still pretty rampant.”
White said rules against Medicare fraud have always been in place. But Stankus said there has been a greater awareness of such fraud in the last several years.
White said his crews have begun telling patients when they feel they don’t need an ambulance to make that trip to the hospital.
“We’ll never refuse to take them in, but we will tell them when transport can be done by another means,” he said.
“Just because you call us, doesn’t mean it’s going to be covered,” Stankus added.
White and Stankus say their crews have received ambulance calls for everything from sleeplessness to broken fingernails. One woman even called a crew to her home to adjust her bed.
White said Medicare also is cracking down on hospital-to-hospital transfers that occur only because the patient wants to be treated at a particular hospital.
“It has to be a transfer to a higher level of care than is available at the sending facility,” White said.
“Medicare scrutinizes ambulance claims more than it ever has,” Stankus added. “Consequently, we might be asking the patient more questions about why the ambulance is needed, especially in non-emergency situations.”
Bill Grimes can be reached at 217-347-7151 ext. 132 or bill.grimes@effinghamdailynews.com.
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