Howard Hickman never had a problem with his health insurance coverage. The retired Union Pacific employee and Navy veteran said he has 100 percent coverage rating from the Department of Veterans Affairs and health insurance through Union Pacific. And he has Medicare.
So he was quite surprised when American Medical Response, an ambulance company based in Modesto, Calif., threatened to send him to collection over his last ambulance ride.
The ticket for the trip from his north Spokane retirement community to Deaconess Medical Center amounts to $782.39.
“I don’t know what happened,” Hickman said. “I’ve never had a problem. I’ve had the same insurance over the past six years, I’ve never had to pay a dime on these things and now nobody will cover it.”
The commotion began about a year and a half ago when Hickman had a severe nosebleed.
“I had bypass surgery and they put you on blood-thinner medication,” Hickman explained. “And my nose was bleeding for 10 hours. I went through three boxes of tissue. It wouldn’t stop.”
Worried that there was something seriously wrong, someone at the retirement community where Hickman lives called an ambulance. The ambulance took him to Deaconess Medical Center, the bleeding was stopped and all was well – until he got the bill.
Hickman, who has great difficulty hearing, began calling his insurance providers but got frustrated with phone-mail systems he couldn’t hear and gave up.
“Medicare said I should have used a different form of transportation, or that the other insurance should cover it,” said Hickman, adding that neither the Union Pacific plan nor Veterans Affairs would pick up the bill.
Then Hickman’s daughter Sheree Wilkinson got involved and, after numerous phone calls to Medicare and AMR, said she discovered that the ambulance ride had initially been paid for by Medicare. The ambulance company told Wilkinson that Medicare then changed its mind and canceled the payment – that’s why Hickman was billed.
AMR representatives didn’t return a call seeking comment.
“I’m not sure how they wanted me to get to the hospital,” said Hickman, who is 81 and gave up driving years ago. “I can’t get in and out of a car on my own.” He walks slowly with a walker and uses para-transit to get around Spokane.
Kathy Dungan, with Aging and Long Term Care of Eastern Washington, said her organization can help seniors figure out their health insurance coverage.
“We do help people with things like this, and we help them understand their health insurance coverage and what’s covered by Medicare,” said Dungan. “Medicare can be very rigid with what’s covered and what’s not covered. It covers limited ambulance services only if transportation in any other vehicle will endanger your health. I think you could appeal this case, I really think you could.”
Rich Roesler, spokesman for the Washington state Office of the Insurance Commissioner, agreed.
“As a rule I’d say always appeal the decision if you feel it’s not right,” Roesler said, adding that his office very rarely hears of situations like Hickman’s among the thousands of calls that come in every year.
Appealing brings on one last problem for Hickman: an appeal has to be filed within 120 days – a deadline that’s long gone.
So for now Wilkinson is negotiating with the ambulance company and has promised her dad to pay the bill.
She’s also making sure Hickman gets a letter from his physician stating that he can’t use other transportation to get to the hospital in case of an emergency.
“Medicare told me that they need a statement saying he can’t take other transportation or they won’t pay, so we’ll take care of that,” Wilkinson said. “Hopefully this won’t happen to anyone else.”