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Hi all,


My father is a nursing home resident. He is going to be transferred to another nursing home that is closer to the family. The nursing home wants the family to pay for the ambulance service or else my father will not be transferred to the new nursing home. We asked for them to submit the bill to his insurance company but they said it doesn't work that way. Are ambulance and/or ambulette services covered through insurance (Medicaid Managed Long Term Care and Medicare) when nursing home resident gets discharged from one nursing home to transfer to another nursing home? He lives in the state of NY and one thing I know for sure is that Medicaid definitely pays for transportation when the member has a medical appointment and needs to go to a doctor/hospital.


Thank you for reading, all responses are greatly appreciated.

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I don’t think his current nursing home can bill your father’s insurance company for the transport to another. You may have to pay out of pocket and then submit the bill to your father’s insurance company for reimbursement.
I am not sure there would be a code to bill for that. If a facility doesn’t have an ICD10 code or a CPT code to bill for a medically justifiable expense, they won’t bill because they won’t get paid. Thus why I do not think his current nursing home will assume responsibility for payment as they may not get their money back. Why should they, when you think of it? It’s a voluntary transfer.
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shad250 Mar 2019
Only thing NH is doing is calling Ambulance service? Ambulance is doing transport. NH gets its cut after service is paid.
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ask the case manager for his Medicaid. If the move is motivated by family convenience and not medically related for treatment plan, the transport will probably not be covered by insurance. But ask the case manager. The facility he’s leaving is not going to go to bat to get you help. Ask the receiving facility if they can help.
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shad250 Mar 2019
If it is a routine medical and not emergency, they could have to be paid upfront.
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Thank you guys! I will call his case manager.
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Medicaid will Normally pay for a Lot of things such as this, Unless Now Medicaid is Choosing to Change some of this.
Pay for it, It is Not that Expensive and Dad has to Go ASAP.
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shad250 Mar 2019
Not necessarily Ambulance transport can cost over $300 for the transport alone without the mileage cost. I know to transport my mom to hospital not far away cost over $400
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Ambulance service probably has a contract with this NH to provide service, many do. Many NH also expect the service to be paid for upfront or no transport. NH gets a cut from the amount paid as well.
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Short answer, no transport to another nursing home is not a covered expense.

Family could do the transport at no cost other than gas, time and lodging if necessary.

Since this move is to be closer to family, I wonder where is he and where will be be going? What is the distance that he will be moving?
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Talk to the Doctor. The Doctor should be able to justify a medical necessity reason for an ambulance transport. It could be psychological and/or behavioral. Have the Doctor place the order.
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When my dad moved from one rehab to another the receiving rehab did everything, the one he was leaving had to have their tail twisted to send his paperwork and get him ready to leave.

Just like a spoiled child that isn't getting their way.
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The ambulance service may not have the ablility to bill Medicare or Medicaid. There is a process that these type of services have to go thru to be approved to bill Medicare or Medicaid. Like said this is not a Medical necessity. When my MIL was going to be transported from Fla to Ga it was 2k and out of pocket.
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In PA, it’s private pay or co-insurance is involved. But still a hefty $$
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I don't like the veiled threat, which makes me suspicious of the relationship.  I had a friend whose husband was moved at great expense once, and the next time she knew better and in spite of lewy body dementia, it worked out okay and she drove him the distance herself.
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jacobsonbob avatar
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jacobsonbob Mar 2019
It's ALWAYS a good idea to be "suspicious of the relationship". If one doesn't actually need medical care during the transport, it probably makes sense to do it yourself--even renting a van and enlisting/paying for help will be much less expensive.

A few years ago my mother had an appointment with a dentist literally across the street from the nursing home. My sister and I got her into her wheelchair and pushed it the few hundred feet to the dentist!
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When my wife finished rehab at one SNF, which said they did not have a LT Medicaid bed, she was transferred to another SNF at my expense. I was told that neither Medicare or Medicaid would pay for transfer from one SNF to another. However if she had gone to the ED and then to a different facility, they would have paid for both trips.
Don't expect to get them to pay for any out of state transfer.(You did not specify if that was the case or not)
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Manson avatar
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Manson Mar 2019
What is ED? I keep hearing that every now and then when my mother was in a SNF and I forgot to ask SNF what that meant.
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In my mom's case, the NH was a short distance from the Hospital. When she was transported to the Hospital emergency or not, they had an Ambulance service, Lifecare, that they used. If it was non emergency the cost was paid up front, before transport, (credit card, in person, etc), No payment, no transport.

Emergency, they would transport, bill insurance, what insurance did not cover, they would bill her for the rest. Mind you, even with the less than 5 mile distance, the cost was still high, with the added insult of the high cost per mile for transport.

If you go with your loved one on an emergency transport, one of the the first things the EMTs will ask when they are loaded in the ambulance is for the SSN to be able to bill insurance.

Hospitals are big business, plain and simple, and other businesses want a piece of the pie.
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Wow, thank you guys for the replies! I was able to resolve the issue by calling his case manager, which Guestshopadmin suggested. They said there's no guarantee that it would have been covered from nursing home 1 to nursing home 2. However, the insurance decided to make this an exception and reimburse us for it, only one time. Thank you all!

Edit: I would love to have taken him myself to nursing home2 but he had to be on a stretcher.
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BeckyT avatar
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BeckyT Mar 2019
That’s great! I’m glad it worked out for you! I’m sure you’ll feel better having him close by.
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There are all kinds of answers. Speak to the heads of the facilities and get information from them as to what they know. Find out who the transporting company will be and talk directly to their billing department. Then call Medicare for their rules and guidelines. Last but not least, for about $30 a year, anyone can join an ambulance group and you are guaranteed five rides per year as long as it is medically necessary. There is no one set answer. It needs to be explored but the answers are out there. Personally, from my own experience, I believe is one is being transferred from one hospital to another, it is always l00% covered - but check it out.
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Cherrysoda Mar 2019
Do you have a link to this ambulance group, never heard of such a thing, sounds great.
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In Florida neither Medicare nor Medicaid will cover transport unless it is emergent going to Emergency Room. There are other hidden expenses. They do not, for example, cover hair cuts. However, you can speak with insurance but I would get it in writing. What they say and what they do are two different things..but overall Medicaid will not cover non-emergency transport.
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needtowashhair Mar 2019
Where I live, medicare didn't even cover it to the emergency room.
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ED means Emergency Dept or Emergency Room
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We just did ROUNDS that took a YEAR to resolve with 911 to an ER with the VA. Let me tell you the 911 folks are happy to put your bill into collections even when the VA or INSURANCE is responsible. BEST thing you can do to not get a hit to your credit is pay for it out of pocket, and then take it up with ins. Took us a YEAR to finally resolve multiple 911 bills that ALL went to the ER and most ended up in hospitalization.

There are also private medical transport companies, cheaper than ambulance I am sure. It all depends on how medically involved he is. Can he sit in a wheelchair? Then he could go with a nurse and insurance in a wheelchair transport van-you only really need an ambulance if he is connected to IVs, tubes, wires, needs a cardiac monitor and all that for the trip -if you have a decent plan- will cover that much cheaper with no payment by you. (We have United).
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Most NH's have contracts with a transport service but they pay for that so often try to pawn transport runs to the hospital for instance on 911 or perhaps get residents to private pay or bill insurance when they can. While I don't know Medicare's parameters for transport it does seem as though if he needs it for doctor visits he would need and should get it for moving NH to NH. But it might be easier to first see if the new NH you are moving to will send their transport to pick him up or bill insurance for you, at least help you figure out what to do. I imaging the place he is leaving isn't wild about loosing a client to a competitor even if it is for good reason so maybe they don't have the incentive to help as much as the new facility. Then if that isn't going anywhere and they don't have suggestions read both contracts and see if there is anything about transport and finally maybe getting a doctor to order it will make a difference with insurance? Perhaps the service the current NH is contracted with doesn't bill Medicare?
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Yes, if you have Medicare and Medicare Supplemental. You say you have Medicare.
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