Hospital v. Insurance Medical Transportation: A question

[PoliSciPulse]

I have a friend who has been denied insurance medical transportation by -- as far as I can figure -- the hospital and not the insurance. He stays at home and is primarily a hermit in the sense that he doesn't have many friends besides me, and I have no license and am over 1,000 miles away. He also has a disabled wife who can have a health emergency at any moment.

The problem: The hospital keeps denying him insurance medical transportation despite the benefit being funded by Medicaid and contracting with the state he lives in. As far as we can tell, he is perfectly within his rights to request insurance medical transportation. Both times he has been denied (again, by the hospital, not the insurance) hit has been because he was under anesthesia. Once was for what more or less amounted to an invasive laparoscopic surgery for what was basically a "liver cleaning" due to a genetic disease, and once he could not go to a different, local hospital for a colonoscopy because, guess what, anesthesia.

My understanding: The hospital has a "you can only leave with friends and family" policy, which seems to be a CYA. Patients under anesthesia, you don't want them passing out in the back of a strange Uber or Taxi, on worse yet, on a city bus. Fine, I understand that. But this is a service contracted through Medicaid, which he is able to receive, and it is contracted with the state he lives in.

My question: Is there any legal justification for the hospital denying him insurance medical transportation, given a) it is contracted through his insurance company with the state he lives in, and b) it is a medical benefit that comes with his Medicaid? And c) the hospital is five minutes away by car, and they are also not offering him their own medical transport. The first hospital I referenced was over an hour away.

If so, what is the justification? If not, who is the best person for him to talk to?

 

[bluesmoke]

Odd. Recovery from anesthesia requires a waiting period in hospital that may take up to 8 hrs, for general anesthesia, to overcome all drowsiness, but much less to simply be an unaccompanied passenger of taxi transportation provided by insurance, which somebody with Medicaid should have. The hospital will ask the patient how they're feeling. As long as a clear unambiguous answer of "I'm fine" is given, that's what they'll go by to release the patient. I'm not so sure we have the full story there.

If your friend is a "hermit", then there is probably a fair amount of social anxiety swirling around that even prevents his contacting the outside by phone and other methods of communication. You could get a medical form signed by him to allow your representing him regarding limited medical matters to serve the purpose of your concern. Then, you could contact the insurance provider and get a better idea of what is going on. Having Medicaid, he obviously is low income and would qualify for free legal advice. You could ask the provider if they could give you any contact info on one. However, they are not supposed to do that. But it seems to me they have no increased exposure. It's worth a try. Nonetheless, you might find free legal advice through research for his state.

Good luck.

 

[PoliSciPulse]

Perhaps "hermit" is not the right word. Able to take care of himself on phone, etc. - actually very endearing socially, just doesn't have a lot of friends (mainly on Facebook) or family (80-year-old mother two hours away) in the area. He's drafted a letter, knows all the numbers. He's just not sure how to go about figuring out how to get home from an appointment that requires a ride home.

Any idea where should he start?

 

[bluesmoke]

Perhaps "hermit" is not the right word. Able to take care of himself on phone, etc. - actually very endearing socially, just doesn't have a lot of friends (mainly on Facebook) or family (80-year-old mother two hours away) in the area. He's drafted a letter, knows all the numbers. He's just not sure how to go about figuring out how to get home from an appointment that requires a ride home.

Any idea where should he start?

Contact his insurance provider. They should provide transportation free of charge. That's how Medicaid should work in any state that has Medicaid. I could be wrong. In a pinch, there's always the neighbor. If of a qualifying age, he can search online for elderly referral service of what he's looking for. This is an exasperating process. Arranging the ride home can be a nervous breakdown such that you might as well walk home. Or hobble.

 

[Court Jester]

My question: Is there any legal justification for the hospital denying him insurance medical transportation, given a) it is contracted through his insurance company with the state he lives in, and b) it is a medical benefit that comes with his Medicaid?

Yes, and you already know the answer. Because a hospital or clinic will not allow a person to leave after anesthesia unless they leave with a friend or family. And the reason is the hospital may need to follow up (which in my experience they always do), and that is not likely to happen through a taxi driver, uber driver, or any paid transport. This is to protect the patient and assure there is a means of two way communication in the even of a reaction to treatment post discharge.

If you feel the hospital is being difficult in helping, then call the insurance company and see if they will pay for a private nurse to help facilitate your friend's transport home from the hospital if he has nobody else to do it.

 

[Pippi Longstock]

Perhaps "hermit" is not the right word. Able to take care of himself on phone, etc. - actually very endearing socially, just doesn't have a lot of friends (mainly on Facebook) or family (80-year-old mother two hours away) in the area. He's drafted a letter, knows all the numbers. He's just not sure how to go about figuring out how to get home from an appointment that requires a ride home.

Any idea where should he start?

I'm not sure but if you have a Department on Aging in the state or area. We have one but I'm not at all sure what they do. The name of the department, I'm pretty sure differs slightly from state to state