By Charles Elmore
The Palm Beach Post
PALM BEACH, Fla. — With lights flashing around her, Joyce Levenstein said she repeatedly protested the ambulance was taking her to the wrong hospital.
Levenstein, 85, called 911 after suffering abdominal pain. But the ambulance took her to Bethesda West, a fraction of a mile closer to her home than JFK Medical Center, where her doctors were, she said.
“My wishes were ignored, even though I was completely aware of my surroundings, alert to all that was happening,” she said. “I am still fighting charges from the hospital, which I feel were done despite my attempts to prevent them.”
Do patients get a say, or is the ambulance destination predetermined by policies the crews use?
The answer might surprise: Patients can express their wish to be taken to a particular hospital for non-trauma cases — “within reason,” Palm Beach County Fire Rescue Capt. Albert Borroto said.
The top priority is saving life and health, of course, so proximity can be critical. But increasingly, the destination can matter not only to a consumer’s peace of mind — to get access to her doctors and records — but also her pocketbook.
For example, hospitals and medical providers that are out of network with a health plan can cost a consumer hundreds or thousands of dollars more than in-network counterparts. Even at a hospital in a network, starting over with fresh tests could be more expensive and arduous than treatment by doctors familiar with a case history.
Levenstein said she underwent tests and evaluation at the new hospital before eventually getting to the old one, she said. The good news is she soon felt better physically. But she was not happy about bills she thought were unnecessary.
Palm Beach County Fire Rescue “encourages its patients to go the hospital that has their records and where their doctor has privileges, within reason,” Borroto said.
He said he cannot talk about particular patient cases, but generally, crews transport patients to “the closest appropriate facility whenever possible and indicated,” Borroto said.
The urgency and nature of the patient’s condition matters, he said.
“All trauma alert patients go to the closest trauma facility,” Borroto said. “Stroke and cardiac alert patients go to the closest stroke or cardiac facility.”
Crews use a hospital capabilities list that specifies any special services that are offered at particular hospitals, he said.
But in Palm Beach County, residents may express a choice of hospitals if appropriate options are reasonably close and there are no other overriding factors, Borroto said.
“If a patient doesn’t meet any criteria to be transported to a specialty facility,” he said, “one of the first questions our patients will hear is, ‘Which hospital would you like to go to?’ “
That’s not how it worked out for her, according to Levenstein.
Online maps show it was 7.4 miles to JFK from Levenstein’s Lake Worth address, and 6.9 miles to Bethesda West.
She wondered if there are ever agreements to steer emergency-room business to particular hospitals. “No,” Borroto said.
Billing in emergency situations can produce a lot of surprises for consumers, but attempts to fix it in Florida have flopped.
Legislation that tried to get a handle on what is known as “balance billing” — handing the patient a bill for the difference when insurers and medical providers cannot agree on a price — failed to pass in the state legislature this spring. The legislation stalled after heavy lobbying from different directions by insurers and medical providers.
Even the ambulance ride itself can produce unexpected costs for the consumer because ambulance services often decline to reach “in network” agreements with insurers.
In May, a third of consumers in a Consumers Union national survey said they have been hit with surprise medical bills.
“Avoiding these types of charges can be difficult enough for a planned procedure, let alone in an emergency treatment situation,” said DeAnn Friedholm, Director of Health Reform for Consumers Union, the policy and advocacy arm of Consumer Reports.
Levenstein said she just wanted to be heard, even over the wail of a siren.
“Just because we’re older, we’re not stupid,” Levenstein said. “We still want a say in how we’re treated.”
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©2015 The Palm Beach Post (West Palm Beach, Fla.)