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Medicare pays on disputed ambulance charges

After several frustrating months battling the Medicare system, I am turning to you in the hope of obtaining a reasonable answer to my Medicare claim.

On Dec. 27, my wife, Else Knabe, was rushed to the emergency room by ambulance because of a pathological fracture of the right femur due to malignant lymphoma. Emergency surgery had to be performed, but because of her malignant lymphoma, it was decided that she needed to have another radiation treatment in order to avoid life-threatening bleeding during surgery.

Apparently this could not be done at the hospital, so on Dec. 28 she was transported, by stretcher and ambulance, to a radiation therapy facility that previously had treated her. She was treated while the ambulance waited to return her to the hospital. Charges for the ambulance service were $381.70 from the hospital and $390.30 for the return trip.

On Jan. 24, Medicare informed me and the ambulance company that it denied payment as "not medically necessary." Consequently, we forwarded a note from the surgeon explaining that the transportation was medically necessary. The claim was denied again without explanation.

I contacted Medicare several times by phone in May and eventually received a statement that it had paid the previously denied return trip to the hospital. There was no mention of the trip from the hospital to the therapy facility. I tried for several days to call Medicare without success.

On July 8, I forwarded correspondence to Medicare, appealing the denial of payment once more; it did not make sense to me to pay the transportation back to the hospital but not from it. Medicare responded immediately, informing me that it did not pay for this service, again without explanation.

I am left to assume that claims are approved or denied strictly on the whim of the individual working the claim. I believe my claim is legitimate but am at a loss dealing with Medicare. The ambulance company threatened me with a collection agency, so I paid the $381.70 to it under protest. I would like to reclaim this amount from Medicare. My wife has since passed away from complications from her illness. Your assistance would be highly appreciated.

As a postscript, after my wife was released from the hospital, she required home health care, for which Medicare was billed $3,186.57. The amount Medicare paid the provider for this claim was $5,887.87, an overpayment of $2,701.30.

Assuming Medicare had made a mistake, I contacted it by telephone. The answer was that Medicare has its own price list for every service performed and payments are made accordingly, even if the invoice is much lower.

The media repeatedly reports that Medicare is getting closer to insolvency. This comes as no surprise to me if it squanders the funds this way. In my opinion, overpayments are not necessary, and Medicare certainly cannot afford them. Gerhard Knabe

Response: Our condolences on the loss of your wife. It has taken us two months, but we can now report that $221.86 has been paid on this claim. The amount represents 80 percent of what Medicare pays according to its fee schedule. You are responsible for the remaining 20 percent as well as the difference between the ambulance company's charge and the amount allowed by Medicare.

Rebate check reissued

I need your help getting an out-of-date rebate check from Corel reissued. When the check was first issued, I was in a stressful situation, taking care of my very ill grandmother 24 hours a day, seven days a week. I bought the product, followed the instructions and got the check. I did not notice that the check said it had to be cashed by a certain date. I wrote to the company and was told to mail the check back for a reissue. I have written many times since then without getting any response. Thank you for your help in getting my $40 rebate check for the luggage I purchased. J. Jordan

Response: Adam Kane, team leader for Corel's customer service group in Ottawa, said you were sending your mail to a rebate fulfillment house that Corel no longer uses. However, because of your multiple attempts to contact the company, Corel will issue you a new check.

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