RE: Refusals and transports

[Guest guest]

But what if XYZ EMS told me (or even scared me) that I need to go the

hospital? I was relying on what I presumed to be valid medical guidance.

Does fraud apply?

-Wes Ogilvie

[Guest guest]

Salvador,

What I was referring to was a situation in which EMS encouraged me to be

transported and it was later determined that I did not actually need emergency

transport and care, beyond the initial medications.

-Wes

[Guest guest]

Salvador,

What I was referring to was a situation in which EMS encouraged me to be

transported and it was later determined that I did not actually need emergency

transport and care, beyond the initial medications.

-Wes

[Guest guest]

In a message dated 3/29/2004 12:28:01 AM Central Standard Time,

scapuchino@... writes:

.. What liability would XYZ EMS have for the remainder of the bills?

I would think so. I talked you into going when you didn't need it. Maybe

even coerced you.... Why not send the bill to XYZ ambulance.

My grandfather (wise old soul that he was) Said honesty is the best policy.

Tell you patient the truth. Let them make an informed decision. But be an

advocate for them when needed. We are there to assist them in their time of

need.

Tom LeNeveu

Learning Paramedic

[Guest guest]

In a message dated 3/29/2004 12:28:01 AM Central Standard Time,

scapuchino@... writes:

.. What liability would XYZ EMS have for the remainder of the bills?

I would think so. I talked you into going when you didn't need it. Maybe

even coerced you.... Why not send the bill to XYZ ambulance.

My grandfather (wise old soul that he was) Said honesty is the best policy.

Tell you patient the truth. Let them make an informed decision. But be an

advocate for them when needed. We are there to assist them in their time of

need.

Tom LeNeveu

Learning Paramedic

[Guest guest]

None, but as far as I know your insurance company CANNOT deny an EMS

transport claim when the reason for the call/transport is classified as SOB.

Talk

about liability-on the part of the insurance company...

[Guest guest]

None, but as far as I know your insurance company CANNOT deny an EMS

transport claim when the reason for the call/transport is classified as SOB.

Talk

about liability-on the part of the insurance company...

[Guest guest]

What precipitated your attack? Why couldn't you treat it yourself? What if

you go into status asthmaticus because one breathing tx isn't enough. I think,

it'd be too risky for insurance to deny...

[Guest guest]

What precipitated your attack? Why couldn't you treat it yourself? What if

you go into status asthmaticus because one breathing tx isn't enough. I think,

it'd be too risky for insurance to deny...

[Guest guest]

I never said that they denied the bill. They said that not all of the

services were medically necessary. What the insurance company did was to

determine

what they felt was medically necessary and then reimburse for that.

-Wes

[Guest guest]

I never said that they denied the bill. They said that not all of the

services were medically necessary. What the insurance company did was to

determine

what they felt was medically necessary and then reimburse for that.

-Wes

[Guest guest]

I see your points. I'm just trying to provoke or foster a little bit of

discussion on whether transport is always necessary.... and the potential

pitfalls

that could result from " steering " a patient one way or the other regarding

transport. The standard is INFORMED consent. That means being a patient advocate

and giving them the appropriate information to make the proper decision.

-Wes

[Guest guest]

I see your points. I'm just trying to provoke or foster a little bit of

discussion on whether transport is always necessary.... and the potential

pitfalls

that could result from " steering " a patient one way or the other regarding

transport. The standard is INFORMED consent. That means being a patient advocate

and giving them the appropriate information to make the proper decision.

-Wes

[Guest guest]

In a message dated 3/29/2004 12:51:39 AM Central Standard Time,

hatfield@... writes:

It could go with anything, lets take away the asthma and put in a 2 "

laceration to the arm, you care for the bleeding which is neither venous

nor arterial. Bleeding is controlled. In other words, your patient is

VERY stable. You place a 4 X 4 and some Kerlix around it, and convince,

or scare, or intimidate (pick your poison) the patient into going to the

hospital because they may need sutures.

Sutures are not an immediate need, but since you insist that they go

with you, they reluctantly agree.

The insurance company denies payment, who pays?

Unfortunately the patient. Why would you talk someone who is otherwise in a

nonurgent situation into riding in an ambulance? I would only transport them

if they insisted.

Tom LeNeveu

Learning Paramedic

[Guest guest]

In a message dated 3/29/2004 12:46:46 AM Central Standard Time,

hatfield@... writes:

You're generalizing that too much. Insurance companies can read the

narrative, so even if you list the nature of the call as SOB, if your

narrative states that the patient was SOB because they just ran 6 miles

while being chased by the local PD, the claim can be denied.

Then you treat 'em, and turn them over to PD. But just like the drunks, they

have the option to go by you or go by PD, most go with us. Besides, you ever

noticed most pt's on the run from the law don't have insurance?

[Guest guest]

In a message dated 3/29/2004 12:51:54 AM Central Standard Time,

hatfield@... writes:

It could go with anything, lets take away the asthma and put in a 2 "

laceration to the arm, you care for the bleeding which is neither venous

nor arterial. Bleeding is controlled. In other words, your patient is

VERY stable. You place a 4 X 4 and some Kerlix around it, and convince,

or scare, or intimidate (pick your poison) the patient into going to the

hospital because they may need sutures.

Sutures are not an immediate need, but since you insist that they go

with you, they reluctantly agree.

The insurance company denies payment, who pays?

Trust me, most insurance companies will not deny. Too many risks for them..

Glass embedded in the wound? Nerve damage? High rate for infection? No tetanus

shot on 20 years? They'd rather pay the little stuff than a 2 week ICU stay

for sepsis associated with a laceration EMS said was fine and may or may not

require further medical attention.

[Guest guest]

In a message dated 3/29/2004 1:00:59 AM Central Standard Time,

cllw602@... writes:

Then you treat 'em, and turn them over to PD. But just like the drunks, they

have the option to go by you or go by PD, most go with us. Besides, you ever

noticed most pt's on the run from the law don't have insurance?

This is the one line from PD that drives me nuts. If offered a ride by EMS

or PD, Duh who you gonna choose. I have had " bad boys & Girls " who fell over

onscene, and the local deputy calls us out. Now mind you when I say fell

over. Standing drunk falls and scrapes his/her hand. Not in an MVA, Not

hitting

head. And this Deputy (same one everytime) runs this offer by them. Guess

what. We have a nonpaid BS transport to ER because this deputy didnt want to

arrest him at the time. AAAGGGHHH. drives me nuts.

Tom LeNeveu

Learning Paramedic

[Guest guest]

Are you going to write on your run form that you felt all the pt needed was a

breathing tx or a spray of NTG, and no transport?

Write what you see, what they tell you, not what your opinion is...

That's not fraud.

[Guest guest]

In a message dated 3/29/2004 1:11:22 AM Central Standard Time,

FireMedic1633@... writes:

This is the one line from PD that drives me nuts. If offered a ride by EMS

or PD, Duh who you gonna choose. I have had " bad boys & Girls " who fell over

onscene, and the local deputy calls us out. Now mind you when I say fell

over. Standing drunk falls and scrapes his/her hand. Not in an MVA, Not

hitting

head. And this Deputy (same one everytime) runs this offer by them. Guess

what. We have a nonpaid BS transport to ER because this deputy didn't want

to

arrest him at the time. AAAGGGHHH. drives me nuts.

Tom LeNeveu

Learning Paramedic

Tom, that's why you have PD place them in protective custody and go with you

to the ER. Let them baby-sit and go through the DC, and let PD pick up the

bill for it.

[Guest guest]

He wont arrest him before we transport.

Tom LeNeveu

Learning Paramedic

[Guest guest]

i dont think they would have any, because YOU as the pt have the right to

refuse transport AMA.

Refusals and transports

> Ok, here's a hypothetical scenario. Let's assume that I need some

treatment

> on scene, and that's ALL. For example, I'm having an asthma attack and I

need a

> nebulizer treatment and a followup with my primary care physician.

However,

> XYZ EMS insists on transporting me to the hospital. XYZ EMS, the hospital

> emergency room, and the emergency room physician all submit bills to my

managed

> care organization. After a thorough review by the managed care

organization's

> claims staff and their medical director, the claim is not fully paid. The

managed

> care organization determines that all was needed was the on-scene

treatment

> and a follow-up with my primary care physician. As such, my insurance only

pays

> for the on-scene treatment and medicine along with the cost of a

physician's

> office visit. What liability would XYZ EMS have for the remainder of the

bills?

>

> -Wes Ogilvie

>

>

>

[Guest guest]

Probably write it off, but more than likely bill you for it. The problem I see

is that most insurances will pay the bill if you needed a nebulizer treatment.

In my area I have yet to hear that a bill was not paid because all the pt needed

was a neb tx and the medics should have told the pt to f/u with his md. can you

imagine then? Insurances would be dictating our protocols. But what you are

talking about I have heard where some managed care center has a call center that

the pt calls. After talking to the pt the nurse/physician on the other end

decides whether you do or do not need an ambulance/hospital er visit. But as

far as MOST private FOR-PROFIT services, I am sure they will continue to tell

medics to do their best to encourage transport. An ideal hospital based service

I think would have a PA or AMD on a vehicle. If I get on scene and can see that

the pt does not need an ER visit then we call him in to go take over the call

and assess and prescribe.

Refusals and transports

Ok, here's a hypothetical scenario. Let's assume that I need some treatment

on scene, and that's ALL. For example, I'm having an asthma attack and I need

a

nebulizer treatment and a followup with my primary care physician. However,

XYZ EMS insists on transporting me to the hospital. XYZ EMS, the hospital

emergency room, and the emergency room physician all submit bills to my

managed

care organization. After a thorough review by the managed care organization's

claims staff and their medical director, the claim is not fully paid. The

managed

care organization determines that all was needed was the on-scene treatment

and a follow-up with my primary care physician. As such, my insurance only

pays

for the on-scene treatment and medicine along with the cost of a physician's

office visit. What liability would XYZ EMS have for the remainder of the

bills?

-Wes Ogilvie

[Guest guest]

Hey Wes can you contact me privately.

scapuchino@...

Re: Refusals and transports

But what if XYZ EMS told me (or even scared me) that I need to go the

hospital? I was relying on what I presumed to be valid medical guidance.

Does fraud apply?

-Wes Ogilvie

[Guest guest]

I think not. There's not going be an EMS provider that will come out and say

" sorry, out medic gave wrong advice. Don't go to the hospital " because then

everyone and their dog will refuse AMA and then XYZ EMS is sued because

someone should have gone to the ER and died and it was XYZ EMS's fault

because they didn't take them.

its a vicious cycle

Re: Refusals and transports

> But what if XYZ EMS told me (or even scared me) that I need to go the

> hospital? I was relying on what I presumed to be valid medical guidance.

>

> Does fraud apply?

>

> -Wes Ogilvie

>

>

>

[Guest guest]

I think not. There's not going be an EMS provider that will come out and say

" sorry, out medic gave wrong advice. Don't go to the hospital " because then

everyone and their dog will refuse AMA and then XYZ EMS is sued because

someone should have gone to the ER and died and it was XYZ EMS's fault

because they didn't take them.

its a vicious cycle

Re: Refusals and transports

> But what if XYZ EMS told me (or even scared me) that I need to go the

> hospital? I was relying on what I presumed to be valid medical guidance.

>

> Does fraud apply?

>

> -Wes Ogilvie

>

>

>