In Your Corner: EMS Dispute

By Ryan Elijah

June 18, 2010 Updated Oct 3, 2008 at 11:09 AM EDT

FORT WAYNE, IN (Indiana's NewsCenter)--
For over 3 years, Jim Newville has been trying to fight a bill he received for an ambulance run. In 2005, he required ambulance service on 2 separate occasions. He expected Medicare to pay the Three Rivers Ambulance Authority it's share and his private insurance would cover the rest on both claims. Medicare did pay on both runs, but TRAA refused one of those checks, and billed Jim for 878 dollars.
Jim Newville "I was so sure I was going to collect it because I knew it was a payable claim, but I was wrong"
Jim has documented both ambulance runs, literally hundreds of pages, including a letter from Medicare saying the runs should be covered, but when we talked to the ambulance authority, they said that verdict is not nearly as simple as it seems
Gary Booher/TRAA Executive Director "even sometimes Medicare gets confused. One person may say it's covered, another may say it's not. Without knowing all of the specific details, they may not have all the adequate information."
The difference in Jim's emergency's is one was defined as a "paramedic assisted service. In simple terms, Grabill's EMS vehicle called in TRAA and it's paramedics to provide service in the Grabill vehicle. Since Medicare only pays for transportation, Grabill was the only provider that could receive compensation from Medicare. Booher says the law is very specific in that states must have a law saying the "basis life support", in this case Grabill, can't bill for service.... Since Indiana doesn't have this law and there's no payment contract between Grabill and TRAA. Medicare can't legally pay TRAA,
Gary Booher "this paramedic assist that we're talking about becomes not covered, which means Medicare will not pay TRAA's bill and the patient is solely responsible. We have to walk this tightrope and make sure we accept everything we should be accepting, but don't get caught in a fraud situation by accepting payment that we know shouldn't be covered"
Gary Booher says 50 percent of TRAA's calls are Medicare runs and he has one full time employee just to handle it's complex billing issues. He says TRAA will allow for monthly payments if needed and can write off a debt if the patient is found to be unable to pay. As for Jim, his bill went to a collection agency, before he started making monthly payments and eventually paid the entire 878 dollar balance off. After trying the attorney general's office and numerous lawyers and organizations, he says he's fighting for principle now.
Ryan Elijah "How much do you thing you should have paid for this? Jim "Zero"
While you can't blame TRAA, for following strict Medicare rules, you also can't blame Jim for being frustrated about a very complex Medicare system and state laws that left him holding the final check

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