When last we met on “I Alone Am Left To Tell You” (https://annecwoodlen.wordpress.com/2011/09/17/i-alone-am-left-to-tell-you/) the problem was that I needed to go to the Emergency Dept. for what turned out to be an abscessed tooth but Medical Answering Services, the local Medicaid transportation dispatch service, said they had an order not to transport to Emergency Departments, so I would have to call 9-1-1. When called, 9-1-1 said I had to take an ambulance. An ambulance costs $527; a wheelchair van costs $27, and I did not need an ambulance. I ended up wheeling through the city streets alone at two o’clock in the morning in order to get relief from unbearable pain.
So this morning, bright and early, I called the NYS Dept. of Health, wherein I was told to talk to Tim Perry-Coon, which I refused to do because I have talked to Tim before and know that he is worse than useless. So I talked to Mark Bertozzi who didn’t know anything about this rule that Medicaid no longer can transport to Emergency Departments, but said he would find out and get back to me. I went to the dentist, spent an hour and a half in his chair getting the abscess dealt with and came home to find one telephone number on my caller ID: Esp C 518-549-5915. 518 is the Albany area code. I was too sick and tired to care, so I went to bed and picked up my email the next day, and it contained a message from Tim Perry-Coon:
Good afternoon Ms. Woodlen,
Mr. Bertozzi and I tried to reach you by telephone, and there was no answer. Thus, I am emailing you regarding our findings on your complaint pertaining to your request for transport to the emergency department.
It is our belief that your request for transportation to the emergency department was appropriate. Indeed, you had no need for ambulance transportation, but the critical need for transportation was real.
We have been trying to address inappropriate transports to emergency departments, where the enrollee is better served by calling one’s primary care practitioner, managed care plan hot line, or traveling to an available urgent care center. Our instructions to Medical Answering Services, and other prior authorization officials across the state, was to not authorize any transportation to an emergency department; if emergency department treatment was required, the enrollee should call 911. Clearly, we did not consider the possibility that there will be times during the night when the only medical option available for an urgent medical need is the emergency department, and an ambulance is not needed.
I apologize that you did not receive the transportation you desperately needed. Our instructions will be modified and resent to all prior authorization officials.
Regardless, I am concerned about a possible future reoccurrence of this same situation, where you will need an ambulette trip to the emergency department during the nighttime hours (you should be able to easily secure an ambulette in an urgent situation during business hours). There is no ambulette company open for business during the nighttime, only taxi providers, which would require you to walk to and from the vehicle. Is this possible? If not, we must accept that the only mode available to you or any other person who is a wheelchair user is an ambulance. Please let me know, so that we can anticipate rather than react.
First, Tim P-C headlined his message “Issue Concerning Late Night Request for Transport.” Wrong. The issue was denial of transport to Emergency Dept.
Second, there was only one entry on my caller ID. If Bertozzi and Perry-Coon had both called from the same number, then the ID system would only have held the most recent call. Otherwise, if you think that two upper-level bureaucrats in Albany are not using the same telephone then Tim is lying, which has been known to happen before.
Third, P-C admits that I was right! There’s a first. My initial contact with P-C was ten years ago when I tried to complain about Medical Answering Service, LLC (MAS). Tim said there was no problem. After the Office of the Medicaid Inspector General investigated, then MAS had to pay back $80,000 and sign a Corporate Integrity Agreement. There was a problem. If Tim had listened to me and done his job then he might have saved the cost of an expensive investigation. But what I later was told was that Tim and Wayne Freeman, co-owner of MAS, were working very closely together.
Fourth, “We have been trying . . .” Who is “we?” Is this a boondoggle that was dreamed up by Tim Perry-Coon or did Gregory Allen, director of the Division of Financial Planning and Policy at the NYS Dept. of Health (DOH), sign off on it? Allen is the head of the budget at DOH and controls and directs about a zillion dollars of the taxpayer’s money. So let’s ask Mr. Allen: was this your idea? Did you know about it?
Fifth, who decided what an “inappropriate transport” is? What research was done? Did DOH do anything more than look at the bottom line of how much was being paid to ambulance companies, decide the number was big and scary, and start cutting? The only way to discern “inappropriate transport” is to compare the transport bill to the admitting diagnosis. Was that done? Was this no-emergency-department edict done with any research? Did anyone ask the Medicaid recipient why s/he called an ambulance instead of a taxi? Did anybody at DOH know anything about the end-point-user before they made this policy?
Sixth, “the enrollee should call 911.” Why? Medicaid is still going to pay for the ambulance, regardless of whether it is dispatched by the company that was hired to dispatch Medicaid transportation, or 911. The payment doesn’t change; it just shifts the decision-making from Medicaid—which is supposed to authorize transportation—to 911. So let me tell you about 911. When I called them, they kept telling me they would send an ambulance even when I said I didn’t need an ambulance. And they did not ask any questions that would screen for “appropriateness.” The major role and purpose of companies like Medical Answering Service is specifically to authorize transportation. (To be continued tomorrow)