Tag Archives: Ambulance

Angels and Sharks…….

Shark in my beer!

Angels really are everywhere.  As are shark infested waters. You just have to be aware of both.  As I was trying to get the best possible care for “L” in the hospital this week I was ‘attacked’ and rewarded at the most unsuspecting times.



After three days of hemming and hawing about how to address his pressure sores, the surgeon did a procedure bed side and decided that he needed to go in surgically the next day. When I came to get a progress report, the caseworker informed me that “L” would have surgery at 1:00 P.M.(give or take a few hours) and then would be immediately sent home.

“No,” I said calmly, the first time.

The caseworker just looked at me with a questioning glance.

“No,” I said calmly the second time. “He’s not having surgery and then put in an ambulance on a gurney with a huge wound on his backside and then sent home where he lives alone and I have to put caregivers in place. Especially since you have no idea when  that is.”

“Well, I understand,” said the caseworker, “but the doctor said he can go home.”

“Well,” I said, “if you understand, then you can tell the doctor the he doesn’t understand, and that this patient, who is non-ambulatory and needs care cannot go home ten minutes after surgery.”

We went round and round a few more times, and it wasn’t a square dance.  Finally she left and returned with the ‘good news’ that he could stay over night after the surgery. What she didn’t know,( or maybe she did as I just was saying: “No, no, no, no, no, no….oh yeah, and no.”) was that I would probably have stood in the doorway with both arms held onto either side refusing to let them take him out.

Angels or Angelicas are everywhere.
Angels or Angelicas are everywhere.

Everything goes well, and we get him home. I entice my sister and her husband to come for a lasagna dinner. It is a sham. I want them, a nurse and a mechanic to figure out a way to invent a seat cushion that will take the pressure off  “L’s” bum. They are kind and helpful and come to L’s apartment the next night. My sister expertly moves and manipulates ‘L’ in his bed so he stays off the sores. It’s poetry in motion how she tells us what to do and how to do it. Meanwhile her husband is taking measurements and cogitating on an invention for the wheelchair seat.

Then his caregivers show up. They take the reins and say, “don’t worry, we will make sure he is turned, fed, his blood sugar is checked and he stays clean.” I am so blessed.

I come in the next day, there is “L” completely naked, having a nice lunch, and saying: “I decided it’s easier for everyone if I just stay naked.” And while on some level that’s true, I really hope the cleaning lady skips this week.

Angels and Sharks, Angels and Sharks.

“You just have to Laugh……”

Cathy Sikorski




Sailed right back into it…….

Lest   (yes, I used the word “lest”) you think a caregiver ever gets a true vacation. Think again. I do not deride my fabulous time in Key West as anything but spectacular and so needed. And I am grateful, truly I am.

A Caregiver's Dream!
A Caregiver’s Dream!

And just as I was winding down that lovely time in the sand and sun and wine and dine, the phone calls began. Trouble was brewing and you, oh mighty caregiver, you were needed pronto.

One of the several disasters going on was that Aetna, once again denied an ambulance transport. I know. I know. We are all so very tired of this same story. But it just gets better and better.

Before I left on vacation, I went to the doctor’s office, who ordered the MRI, gave them a copy of the denial and asked them to write a letter explaining that my brother-in-law is not at all ambulatory and needed the gurney so that he could be lifted on to the MRI table and then transported back home. The woman who handles that task was out to lunch. Oh please, that joke is just too ripe for the picking!

“Hello, is this Cathy?”

“Yes, this is the administrator from the doctor’s office. I did get a call from Aetna and told them we did not order an ambulance for your dad (yea, sometimes I’m his daughter, sister, wife, whatever works). And when they said a ‘Cathy’ called I told them it was his daughter. So that’s why they denied it. ”

First of all, thank you? Thank you for telling them you didn’t order the ambulance and for not explaining that you did though, order the test, and that he would need an ambulance to get there.

What I said was:

“Yes, I called Aetna because for the last three years, your office refused to do that, and so I made the call to get him to the test. You see, he’s not ambulatory so he can’t have any tests on a table unless he goes by gurney.”

“Oh that’s not true, he could go by wheelchair.”

Yep. She really said that. Or she was still out to lunch. I’m not sure which.

“Noooooooooooooo…..he can’t get out of the chair and up on the MRI table.”

Dead silence.

“Well,” said the administrator, “I’m going to have  to have to check with the doctor. We’ve never written a letter before for something like this.

See, not only have they done this before, but I actually sat at the desk with the last administrator and helped her write the letter.

“So, if the doctor approves this, in the future will you call the ambulance for any test he might order?”

“Oh no. We don’t do that.”

You have to go on vacation and then……………

“You just have to Laugh….”

Cathy Sikorski

And the Winner is…………….

As every caregiver knows, I have been frustrated so often by insurance companies and physicians offices that I, well…started a blog.

If  you’ve read my : Never call an ambulance if  you’re old…..Part 2  and  Ambulance…”part trois”….., you know that one of Medicare‘s absurd rules is how to transport the infirm. They will pay for transport from facility to facility, but they will not pay for transport from your home to any medical appointment or hospital test (with certain exceptions). So, if you are completely wheel chair bound, like my brother-in-law, have no use of your legs, and your doctor orders a CAT Scan or MRI, or even the lowly X-ray, you:

A.  Can’t get there

B.  Can’t get ON the table when you get there

C.  Better have a bucket of cash stowed somewhere to pay for private transport

After days, weeks and months of figuring out the rules, and hacking at the system. I found that if my brother-in-law could be transported upright, so that he didn’t have to get out of the wheelchair, he would have to make all the arrangements with the ambulance company and pay for it himself.

If, however, he needed to get on to a medical table for any kind of test or examination AND the test or examination was at a hospital, then Medicare would pay for the ambulance and I would still have to make all the arrangements for transport.

This is how I found that out.

Medicare denied payment of a transport for a CAT scan. I followed all the rules, contacted all the right people. Got all the pre-certs, the approval numbers and the referrals. But since I had already scheduled the scan, I just used the information the insurance company gave me and had the test done.

Several weeks later, I get the denial for payment. I made a thousand phone calls, appealed the decision, twice, and was still denied as transport not an emergency or medically necessary.

Now I had to appeal to an Administrative Law Judge. This law degree I have and over 15 years of practice in Elder Law came in handy. I jump in with both feet and file the appeal. But because I’ve been around this block many times with many people, I know that a simple paper appeal will not work. Short of asking the ALJ to come to my brother-in-law’s apartment and see how the hired caregivers get him ready for the day, I’m pretty sure the information I would send would not shift the decision.

Yay….social media…..Yay….youtube.

I get up very early in the morning and with my brother-in-law’s approval, I take that amazing little iPhone I have and make a movie of the two caregivers dressing him, washing him, lifting him out of his bed and into his wheelchair, combing his hair,  helping him brush his teeth and shave, and giving him a nice pat on the head to have a good day.

I make a copy of the video, put it on a CD (yeah the Medicare appeal system isn’t that tech savvy that I could upload it), mail it to the judge, and wait.

Lo and behold after 3 hearing cancellations by the insurance company, I get a phone call from the judge’s office saying that the insurance company has decided to pay the claim and there would be no hearing.

I take a bow and accept my Oscar for best performance by  a caregiver.

You just have to Laugh……

Cathy Sikorski

Just searching for approval….not PRE-approval

I have been so lucky with my brother-in-law, L this  past year. He has been pretty healthy for a guy with MS and relegated to a power wheel chair. The year before he was very sick off and on and required boat loads of my time. But this year, he has just been doing remarkably well, which led me into this complacent place of thinking all is well in the medical world….at least with L.

And actually, he’s fine–ish. But we are now in a push to get some testing and medical work done before the end of the year. And I just forgot how to do things, and how things would be done to me.

On Monday, L needs an ultrasound to check a worrisome kidney cyst. Okay,  I set up the test at the correct hospital and the correct facility of the hospital. His Medicare insurance requires him to go to certain facilities. Sometimes the ordering physician knows that and sometimes he doesn’t. But after 10 years, I KNOW it and so I set up as many of these tests without their “help”, so we don’t have insurance issues in the future.

I make sure the test is between his breakfast and his dinner, because even though he’s gained at least 40 pounds in the last three years, he gets really cranky if he misses a meal. I get that….it’s part social, part his inalienable right, and part “I’m hungry!!”. Okay, no sweat.

I call the ambulance transport and set up transport to the facility and the eventual doctor’s appointment to discuss the results of the test. And I even make sure the blood work is scheduled to be done at his apartment as a “home draw”, which requires a request to the lab directly from the doctor’s office, because I am not PERMITTED to ask the lab to come to his apartment, since  he is wheelchair bound and has no  transportation….ONLY the doctor can do that. (who of course, doesn’t ever remember that and so must be reminded by me, and then the lab calls me to make sure they can come at a convenient time…UGH does this really make ANY SENSE TO ANYONE????)

And then I realize, three days later, and three days before the test. Oh crap, I didn’t get PRE-CERTIFICATION for the ambulance, which must be a gurney and not a wheel chair transport  (which we will discuss another day) because he must be put on a table for an ultrasound and he cannot get out of the chair and onto a table by himself.

So…………….I call for the pre-certification:

“Hello, I’m calling for a pre-certification.” (This of course, after pushing 42 buttons and getting disconnected, and being asked at least four times: “are you calling for a pre-certification?)

“Okay, can I have the name of the member, his ID number, his date of birth, his first born.”.(okay they didn’t ask for that, but they might as well have)

And after I get it all squared away, I think…

“Now, you will have to have the ambulance transport company call us to request that.”

“Well, I’ve tried that before. First of all, they won’t do that. Second, in order to request this you need the prescription, the diagnosis code and the physician’s name, am I correct?”

“Well, yes, so that we can approve that it is medically necessary for him to have transport.”

“Well, the ambulance company does not have the prescription, I do. And furthermore, I wouldn’t give it to them, nor do they want all this medical information on my brother-in-law. Not to mention that I’m pretty sure it would violate like 100 kinds of HIPPA laws to be passing around his diagnosis and doctor names and medical test information, don’t ya’ think?”

“Umm, well………Can you hold for just a second?” the nice lady at the insurance company says to me (the mean lady trying to get ambulance transport for the hundredth time with the same argument for the past three years)

“Okay,” she says as she comes back on the line, “can you give me all of that prescription information?”

“Of course,” I say. NOW, I hope against hope that we are really almost there.

“Well,” she says, “that will do it!” Very bright and chipper I might add!

“Oh, no, no, no,” says the voice of experience, “I need an authorization number,” knowing full well that the ambulance company won’t transport without it.

“Well, okay, I can give that to you, but this has to go to our medical team to determine if it’s approved. You will get a confirmation in 2 to 3 days.”

“Okay,” I say, “just give me the number.”

Because I know their dirty little secret. They will approve this BY MAIL in a week, if I’m lucky. But I will not cancel the test, because they will put on their approval that the transport is approved for the day of the test, effectively making it retroactive. But if  I wait for pre-approval, I will magically have to know when the approval will come in to schedule the test since they only approve a specific date. Don’t overthink it. It’s complicated and stupid. I’ve played this game so many times, I just know how to do it. Trust me.


You just have to Laugh……………………..

Cathy Sikorski

Related articles

Ambulance…”part trois”…..

Just a very brief update…..

I am taking my cell phone with me absolutely EVERYWHERE. I am NOT going to miss the call again from the Medicare independent contractor, CMS. Because, as you know, if you miss the call, you can NEVER talk to anyone. Out of sheer exhaustion one afternoon this week, I go to lie down, just for 20 minutes or so, and put that cell phone under my pillow…like shotgun….I am NOT going to even think about RESTING without that ordnance by my side.

Lo and behold, that cell phone vibrates under my head like a 25 cent bed in a cheap motel. Of course, I’m in  a dead-to-the-world sleep, but, as a caregiver, I am so committed to alertness that any signal of distress, alarm, help, or hunger has me jumping up like a thoroughbred at a starting gate.

“Hello?  Hello?” I’m yelling into the phone like it’s a crank phone with a party line.

“Hello. may I speak to Cathy?” says the other line.

“Yes, this is me,”I say.

“This is Rebecca at CMS, the independent contractor for Medicare Appeals!” (you may wonder why I always put that in italics. It is because they use that phrase like it is a papal dispensation for everything that is about to follow)

So I carefully and slowly and without rancor(really I try as hard as I can to keep under control, “more flies with honey than with vinegar” theory) explain to Rebecca that I have sent them the necessary documents for my AUTHORITY for this appeal, three times.

( n.b.(which means ‘note well’) they readily admit they have all the documents for the ACTUAL appeal, they just claim to not possess the documents needed for ME to appeal. And you wonder why caregivers sometimes pretend to be 96 year-old men just to get something accomplished. I digress……)

To her credit, Rebecca stays on the line with me for 10 minutes or so and by listening to me  as I document every date and page I have sent them, and looking, really looking: EUREKA! She finds ‘my authority’!

“Ok, she says,” now I have to see if it was filed in a timely  manner.”

Since I KNOW it was filed in a timely  manner, I just sit on the other end of the phone with steam coming out of my ears waiting for her to confirm that.

As we wrap it up, she tells me:

“Okay you will get a confirming letter re-opening this appeal from it’s dismissal in about 2 to 3 weeks. Then we will review the appeal and send a notice of our decision.”

“So, just so I understand, since I have to report this to the collection agency,” I say through clenched teeth,”you will let me know you FOUND the paper work I’ve sent you three times and THEN weeks or months from now you will let me know your decision on the appeal?”

“Yes, ma’am, that’s correct.”

“Thanks, Rebecca,”I say as I reach  for the Pinot Grigio and go back to bed.

You just have to laugh……..

Cathy Sikorski

Never call an ambulance if you’re old…..Part 2

I think I have spent about $5,000  ( at least in legal time and photocopying) trying  NOT to pay an ambulance bill. I began this tale as one of my first blogs, Do you really need an Ambulance? I think not. I related that my dear 95 year-old mother-in-law was found in pain in her assisted living facility, and the staff correctly called an ambulance. Her pain was evident, so even though she suffered from dementia, which was documented, the ambulance drivers decided to take her to the hospital.

For over a year now, I have been fighting with Medicare to pay this bill. I have told the Ambulance Company, I will not pay this bill, as there is no way my mother-in-law could have made the decision to go to the hospital, let alone  CALL for an ambulance. I do not wish to leave these hard working emergency first responders without pay. However, there has to be some manner in which they can support the patient when the first responders make a medical call, that requires an ambulance.

My mother-in-law does not drive. She has never driven. She has never had a car. In an assisted living facility, she has no transportation to go anywhere without it being directed by someone else. The facility is also doing the right thing by calling for an ambulance for a client who seems to need medical help.

Okay, so we’ve established that everyone who actually PARTICIPATED in this trip to the hospital made a rational and correct decision. The only people who don’t agree with this is Medicare and it’s not even Medicare. It’s a company called CMS, an independent contractor, who assesses whether the claim should be paid. So I send 22 pages of documentation with a letter of explanation telling this independent contractor why they should pay this bill.

The first denial is because this darling old lady really didn’t need to go to the hospital. They found nothing wrong with her and sent her home. Yep…..that’s absolutely true. But, I persist with an appeal.

The SECOND DENIAL is because I have NO AUTHORITY to appeal. I call to clarify this.

” If you would like to leave a message, please leave the appeal number, the claimant’s social security number, the date of service and the provider for which you are appealing. Please leave a phone number and we will return your call.”


They do call me back, and I explain that I am holding in my hand the appointment of representative form that gives me authority to talk to them AND to APPEAL.

“O well, sometimes Medicare doesn’t send us all the paper work in the file so you need to send it to us again.”

I grind my teeth. Call the ambulance company AGAIN to reply to the bill they have sent ME again, and tell them I am still appealing.

The THIRD DENIAL comes because they still didn’t get my paper work. I call them again and they say….”oops”….and ask me to send it again. I ask the representative to explain to me how I will know if they get it…she says:

“Well you might get a notice that we received it…..wait, no, no I don’t think you will.”

Yesterday, I got the ambulance collection agency notice. They are going to sue my mother-in-law, which I kind of want to let them, because she died.

But I leave a message for the independent contractor, who calls me when I am in a meeting and can’t answer the phone. AND THE MESSAGE IS:

“This appeal was dismissed twice for failure to have the proper paper work to authorize you to appeal.”

I am not fing kidding. I’m not.

I was just going to pay the $797.20 bill. I mean they are just wearing me down to the nub. But I decided to give it one more try. I’m waiting for the return call.

To be continued……

And you really, really do…….

Just have to laugh….

Cathy Sikorski

“A girl should be two things: Classy and Fabulous” Coco Chanel

My Auntie J from Australia is  fashion plate.  At 90 years of age and barely 90 pounds, she is a wisp of a girl, who never looks anything but chic. Even her ‘sweat suits’ are more along the lines of Juicy Couture than what I wear to the gym. When I met her almost 30 years ago, she was never without a matching handbag for her beautiful and expensive shoes.  In my ignorance of thinking back then(before I realized now how young 60 really is)that this was an ‘old lady’, I was also thinking, “damn, she’s a fine old gal with great taste!”

Up until last week when we had to take her to the hospital for the first time in 25 years, she had her hair done (as a blonde…..never gray) every week, and her nails done as well. She was an extraordinary example of fine grooming, beauty, grace, and the true benefit  of “just a little lipstick, never hurts.”

So after ten days in the hospital, where she was really very, very seriously ill, we took her yesterday to a rehabilitation center. For very complex reasons, she went to a center two hours away. The ambulance drivers were two young adorable men, who treated her like their very own dear grandmother. By the time we met up with them at the end of the trip, she was holding their hands and kissing them goodbye.

She had been very concerned about the fact that she was transported in a hospital gown, but I reassured her that we would take her clothes and pretty pink nightgowns to the rehabilitation center, so she could be properly dressed there.

My husband and I have been very concerned for her health during this time and my mom, a former nurse has been right by our side the whole way, comforting, advising and just being a strong shoulder. But because my mom was a white uniform, starched hat nurse of the 40’s and 50’s, she has looked askance every day at the ‘sloppy’ nurses, aides, and technicians who have come to care for Aunt J.

“Look at that,” my mom would say.

“What?”, I ‘d reply, expecting an inept stick of the needle to draw blood, or a hospital meal that was not up to snuff.

“Look at how that nurse’s trousers are dragging on the floor, and no one has their hair up in a bun or a pony tail.”

“Well,” I say, “I guess we just have to overlook certain things when we are happy with her care.”

Of course, now I’M thinking something is terribly wrong here. And then I realize that my mom has much higher standards for dress and presentation than I, or the world, does any more.

So knowing Aunt J and her true art of dressing and personal presentation, I start to wonder if this is bothering her too. She never says anything and the following incident makes me realize that for Aunt J, it isn’t about how people look to her, it’s about how she presents herself to the world.

We get to the rehab center, and one of the last things I want to make sure of, is that Aunt J knows how to push the red button to call for help. With my mother-in-law, when she moved to assisted living, and with many stories from friends about their elders, I KNOW that this ‘pushing the button for help’ thing is somehow difficult for them to comprehend.

So I disconnect the button from the clips on the side of her bed, and make sure the cord is long enough so she can have the button at her fingertips. This particular button is like a tube with a bright red button at the top.  So you would hold it in your hand, curl your fingers around the tube, and push on the bright red circle at the top of the tube with your thumb. That would be how most people would use it, and probably the easiest way.

I bring the tube close to her, and I pantomime what I want her to learn…pushing the button. And I’m telling her, “if you need help, you push this red button.” I put the tube in her hands and tell her:

“Now you practice. If you need any help, I want you to PUSH THE BUTTON.” And again, I show her what to do.

My darling, beautiful Aunt J, shakes her head in the affirmative, looks me straight in the eye with her beautiful blue-green eyes, looks at the tube that I have placed in her hand with the bright red button on top, takes her other hand, rubs the top with her index finger and promptly ‘applies’ the beautiful shade of red lipstick I have given her to her luscious lips. Classy and Fabulous.

You just have to laugh………………….

Cathy Sikorski

I am ready for my close up, Mr. DeMille

You probably have noticed that whenever you go to the doctor now you must have a photo ID. And said photo ID must be valid and up to date, especially if you are a Medicare patient. So don’t even THINK that  you are going to pass muster if you have that dirty old expired driver’s license, a left over ID on an old ratty lanyard from two jobs ago, where there was actual security or that expired passport that you haven’t used in 20 years because you’re now 85 years old.

So this can be a dilemma for the old, infirm or disabled. Here is the story of my brother-in-law, “L”, who continues to be and will forever be wheel-chair bound with Multiple Sclerosis.  This photo ID requirement is fairly new. I remember going to L’s house, struggling to get him down the stairs, into an electric wheel chair in the basement, into his manual wheel chair and out to the car for a doctor’s appointment. And I remember the first time they asked for a photo ID. Now, he didn’t drive to the appointment, and for some reason we forgot his wallet, so there we were, high and dry. But since it was the first time they asked for photo ID, and he had been a patient there for FIFTEEN YEARS, they were willing to wait for his next visit to keep a copy of his lovely face. It was probably because he also was not on Medicare at the time and so they wouldn’t get in any trouble for not recognizing a patient from a decade and a half and requiring that pesky photo.

Okay, so lesson learned. Now, for the past five years or so, I always take that photo ID. But about two years ago, I noticed that his ID, which is his driver’s license, was about to expire. L doesn’t drive anymore. He can’t. He would be a menace to society, and he took that driving privilege pretty darn far. But, and thank God, they still send him a driver’s license. I was perfectly willing to get him a ‘government issued ID’, until I discovered the requirements. In order to get this ID, he would relinquish his driver’s license and apply for the ID, but he must show an electric bill, or a rental agreement, or a deed, to show his valid address. Never mind the fact that his valid address is on the driver’s license which they gladly give him without any of those requirements. L is in a facility. He doesn’t pay an electric bill, he doesn’t really have a rental agreement and he only has an apartment number within the facility for his mailbox. So I asked myself: “Is it easier to go through this craziness for an ID, and perhaps be left without one, OR is it easier to just go get his picture taken and keep the damn driver’s license?”( Since no one is saying he can’t drive and/or even asking if he does drive).

Well, of course, I will just take him to the photo center, wheel him right up to the camera, and SNAP, we’re done. NOT SO FAST, CRAZY CAREGIVER. Now that he is wheelchair bound, and I truly can’t lift him or  help him in and out of a car, I have ordered wheelchair transport for him for all of his appointments. He has to pay for this because Medicare won’t pay for  you to go to the doctor. They will only pay for you to go in an ambulance (and even that is suspect…see my blog ‘DO YOU REALLY NEED AND AMBULANCE….I THINK NOT posted 06/28/2013). So you see you can’t keep yourself from getting sick, or take good medical care of  yourself. Insurance just wants you to get really, really, really sick and THEN you can go to the doctor.

So we pay for transport. Okay, fine. I call the transport company:

“Hello? I need a transport.”

“Okay, to where?”

” I need to transport L (they know L, he’s a regular like on Cheers!) to the driver’s license photo center, so he can get his photo ID.”

“Oh, sorry, no we can’t do that,”

” What? What do you mean you can’t do that?”

” We can only transport him to any medical facility or for any  medical necessity. Our insurance does not permit us to transport for any willy-nilly reason.”

“Hmmm,” I say as I restrain myself from ripping out a hunk of my hair,” but we pay privately. WE PAY EVERY PENNY FOR HIS TRANSPORT. OUR INSURANCE WON’T PAY YOU.”

“Yes, I know, I understand what you mean, but I’m talking about our liability insurance. We can only transport for medical reasons. We are an ambulance company.”

“Ok, fine. Do you know any transport company that is NOT an ambulance company that will transport L for reasons that do not appear medical?”

“Ummm, no sorry.”

“Really? You’re in the transport business and you don’t know anyone else who can help us?’


“Well, thanks, that’s just swell.”

So I suppose the alternative one…the ‘government issued ID’ is the way I have to go, or he won’t be allowed to go to any doctors or hospitals.  I just have to figure out how to meet their requirements to show  his valid address. I want to scream… wait, I think I am screaming and no one hears it. AND THEN THE GOOD SAMARITAN ARRIVES.

L and I had an appointment the next day with the ambulance company for a LEGIT doctor’s appointment. I couldn’t help myself. I lamented to the driver that I couldn’t get L to the photo center, and it was kind of a medical necessity because he needed that ID to get treatment anywhere. So after the doctor’s appointment, we made a quick stop at the photo center, rolled right in there where no one was waiting. SNAP! took the adorable photo of L…and we’re good to go for another four years. Can’t wait to see how I tackle this one the next time around…..O SNAP! Thank you good Samaritan.

You just have to laugh…….

Cathy Sikorski