Insurance/Medicare
So my father is 90 years old and in a nursing home, he is essentially bed ridden, can't stand or walk at the moment (but he is getting stronger) and can't really be put in a car. He developed a potentially dangerous bacterial infection so the NH sent him to the hospital by ambulance. After a few days infection was under control so the hospital sent him back to the NH in an ambulance. He has an Etna Medicare advantage plan, as a retired Prudential Employee.
The ambulance company sent a bill for $2100 saying that the Etna/Medicare only paid $400 and that $1700 was my dad's responsibility because they are not in Etna's plan (not contracted). The argument was that they did not agree to the discounts that Etna requires in their contract. Not only that the bill was only for the ride back to the NH because at that point it was not an emergency. Even though there is literally no other way to transport him and no one asked if the company was in Etna's plan. He is 90 yrs old but still weights 180 lbs and can't be picked up and put in a car. The ride there was covered 100%.
Anyway today i got on a call with Etna and the ambulance company. Etna telling the ambulance company that even though they are not contracted with Etna, they are still contracted with Medicare and based on that are not allowed to "Balance Bill" the patient. They are required to honor the discounts.
The ambulance company will essentially be taking this under advisement and let us know in a few days if my dad still needs to pay.
I am hoping Etna is correct. Can someone please confirm or deny this?