Changes to Medicare are leaving some patients stuck with the bills

12 11 2007

Flo Nibbling, 76, a Medicare recipient, for years never paid a cent for medical emergency treatment in her home or ambulance transport to the hospital. Then, in July, she fainted. It was the beginning of a stroke. A bill for $444.35 from the company that treated her arrived soon after. The bill noted that Medicare had denied the claim. Formerly, Medicare had paid 80 percent of the bill and her secondary insurance would have picked up the rest.

Nibbling says she hasn’t paid the bill because she doesn’t have the money.

“I’d rather die in my living room,” Nibbling said, “than pay bills such as this.”

Nibbling’s experience is the result of recent changes to Medicare’s billing system, that has municipalities fighting with hospitals over emergency medical care bills. State officials say Medicare billing, along with a decline in the number of ambulance corps volunteers, are resulting in a near-crisis for the state’s emergency medical services, or EMS, system.

“To prevent a crash of the system, we have to conduct preventative measures,” said David Gruber, assistant commissioner for the state Department of Health and Senior Services, by telephone last week.

Medicare at one time accepted bills from multiple emergency service providers who responded to a single 911 call. Then it announced it would accept only one bill, even if two providers were involved. Finally, last year, Medicare phased in new payment rates for EMS providers that drastically realigned who would get how much. As a result, patients are getting bills for what Medicare won’t pay.

Meanwhile, hospitals are making slimmer profits on the highly skilled technicians they send out, while ambulances dispatched by municipalities are pocketing money hospitals used to get.

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