Question
Hi,
My father has both BCBS Federal Employee Program health insurance and Medicare Hospital Insurance(Part A).
-Whenever he has to go to the hospital, either planned or through an ambulance emergency call, all kinds of bills come in afterwards from various doctors and services, some within network, some non-participating provider. I'm sure you know about this problem. The question is--is there any way to manage and authorize or NOT authorize anything that anyone wants to do when he is in the hospital?
-A related question is about the ambulance service itself. How is it determined whether a city EMT shows up or a private ambulance service when you call 911? And is there any way to manage the cost on this?
Art
Answer
Hi Art
You don't ask easy ones, do you.
I do not know: A, If he opted out for the Federal program or Medicare. I am guessing he opted to stay in the Federal program, and not Social Security with Medicare. My guess is the Federal.
B. What type BC he has: a HMO or a PPO or what. My guess is a HMO or a PPO.
I believe one of the main problems is that the master computer may have the wrong information regarding his statue. Call the Coordination of Benefits(COB) unit at 1-800-999-1118 and see if their information on his status is correct. If not have them send you a form to make the corrections.
It might be that when he goes to the hospital, the wrong insurance card is being presented.
Regardless, when there is an emergency out of network items are usually covered, If they are denied, they should be appealed.
As for emergencies it is hard to give a correct answer. Most cities have regulations about EMS emergency runs as to which ambulance takes the patient, and it is not unusual for the patient to be responsible for an EMS run fee.
I am going to refer you to my counterpart in your State. They can meet with you and figure out this mess. Go to Medicare.gov=====precede to HOW TO FIND A SHIP OFFICE IN YOUR STATE---click on your state and you have the number. Give them a call and you will get the nearest office to you. They are Medicare trained and can meet with you and go over the problem.
Hope this helps.
John
