Medicare / Hospice / Hospital Bill

I’m in need of the expertise of the community.

Dad was enrolled in Hospice on April 5. My brother signed the paperwork, and spoke with the facility administrator, the nursing director, and the nurse practitioner assigned to the facility.

On April 8 he got a call from the local hospital saying Dad was in the ER. Brother asked why since Dad was enrolled in hospice, so the hospital sent Dad back to the facility.

Now we have a $6,000 bill from the hospital because Medicare won’t pay since Dad was enrolled in Hospice, and Hospice won’t pay because they weren’t consulted with the ER visit.

Has anyone dealt with something like this?

B

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How did he get to the ER? Someone either took him or called an ambulance. Seems like that entity may have some responsibility - most likely the hospice facility.

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Does your father have a DNR (Do Not Resuscitate) on file? If yes, then it is the responsilibity of the hospice to pay the bill. If no DNR, then being in hospice (reasonable expectation of death in the near-term future) contradicts no DNR.

We believe the facility called the ambulance.

Since neither myself nor my brother were closeby, it had to be the facility.

B

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Yes, he has a DNR.

Hospice says they didn’t approve sending him to the hospital, so they won’t pay.

B

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That’s wild. Certainly there would be a record of the fact that the ambulance picked him up from their facility. May even be a 911 or other recording of the call. If he was in their care at the time then they have custody of him and are responsible - I don’t see how it can be otherwise. It might be time to have a meeting with the person that runs the hospice facility.

In the end, you might simply have to ignore the bill. If you have set up his financial affairs sufficiently, there will not be an estate left to pay the medical bill and it will be dismissed by the hospital as unpaid debt. Regardless, I would be sure to make a stink about this in your local community. It is rather rediculous.

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Are they claiming that someone came into the hospice and kidnapped him and brought him to the hospital? In that case, their lack of adequate security is at fault.

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He was in Assisted Living. The assisted living facility sent him.

B

He was in Assisted Living. The assisted living facility sent him.

Then Assisted Living should clearly pay. They knew he was in hospice, and that he had a DNR. I think it’s worth consulting with an eldercare attorney.
=sheila

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My attorney gave me the names of some people who help with medical billing. We’ll see what they say.

Based on the notes, he had a UTI, which would not be covered under his hospice diagnosis.

B

But who made that diagnosis, the ER or the AL facility? UTis usually require an analysis of a urine sample. I don’t think the AL facility would be equipped to do that.

I spoke with a medical billing specialist recommended by our eldercare lawyer. She said start with appealing it through the insurance.

If that doesn’t work I can hire her to get involved.

The UTI diagnosis was done by the ER.

B