Senior Care Action Network, or SCAN, a Long Beach-based Medicare HMO plan that provides services to help patients avoid nursing homes as long as possible, offers patients round-trip, door-to-door transportation to health appointments for $8.50.
But these plans are exceptions.
"Normal transportation is not covered; medically necessary transportation is," said Kaiser Permanente spokesman Jim Anderson. He said Kaiser covers ambulance transportation in an emergency or when it's authorized by a doctor and entails airway monitoring, cardiac monitoring, IV lines or other medical attention during the ride. Kaiser doctors may also request nonemergency ambulance service to transport a patient.
And the transportation shortage is often worse for patients enrolled in Medi-Cal. Door-to-door wheelchair or van services contend Medi-Cal doesn't pay them enough to make it worth their while to carry patients and wade through the paperwork required to get the trips authorized.
Secure Horizons, a Medicare HMO run by Pacificare, doesn't generally cover nonemergency transportation but is helping plan participants locate rides through a community resource guide.
Given the few plans that provide rides, local communities try to offer what they can.
Many Southern California communities offer dial-a-ride or curb-to-curb transportation services for seniors, the disabled, and others who need help getting to medical appointments (many also take them to nonmedical appointments as well) either free or for a small fee, but these may not always be convenient for patients with special needs, said Eileen Harper, acting executive director of the Center for Health Care Rights in Los Angeles. Some require transfers or long waits. Others won't cross city boundaries.
Doing Whatever It Takes
Health care facilities are increasingly improvising to make sure their patients get where they have to go.
Parkview Community Hospital Medical Center in Riverside, an area with a large number of retirees, operates its own transportation service. And UCLA Medical Center provides a van to bring its community clinic patients to and from the main medical center in Los Angeles for tests, chemotherapy or other special treatments, said patient service representative Lisa Peltekian.
At Windsor Manor Retirement Community in Glendale, executives say they're lucky: They operate two buses and a van at a charge of $1.50 per round trip and can't imagine how other facilities operate without such vehicles.
Many HMOs require their patients to come in for care, rather than be treated by medical staff at the facility, said Mark Herrera, Windsor Manor's executive director.
"We had to figure out a way to get them there."
Flagship Healthcare, a 157-bed nursing home in Newport Beach, is a typical facility with many Medi-Cal patients needing frequent rides to medical appointments. It's especially tough for their staffs to arrange those rides on short notice because of the extensive paperwork involved in getting a Medi-Cal authorization, said executive director Peter Steamblock.
"It's very rare we can get a service out there to transfer a Medi-Cal patient on demand," he said. "We just revert back to the family and say you have to take responsibility getting this patient to a doctor appointment. Many times they're just not available to do that. So the patient's treatment either gets delayed or put off indefinitely."
Steamblock and other residential facility administrators say some transportation services limit their Medi-Cal trips, in part because of low reimbursement rates and the paperwork burden.
But that could ease a bit. Gov. Gray Davis in May proposed a 20% Medi-Cal increase for nonemergency medical transportation. Medi-Cal currently pays $117.16 for a nonemergency ambulance trip, plus mileage, and a base rate of $14.71 for a nonemergency van trip for a single patient, according to the California Department of Health Services.
"We're concerned. We do think we have an access problem now. That's why we put such a large increase in," said Stan Rosenstein, the department's assistant deputy director of medical services.
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Resources for Catching a Ride
The Los Angeles County Area Agency on Aging can advise seniors on transportation services available in their areas. (800) 510-2020 and (213) 738-4004
* The city of Los Angeles' Department of Aging can provide applications and referrals to the City Ride program. Disabled city residents may request information on the county's Access Services program. City residents over 60 can request referrals to a senior center in their area where they can obtain services. (213) 368-4030
* Two local organizations within the statewide Health Consumer Alliance can help hook up seniors with transportation services. The Health Consumer Center of Los Angeles, part of San Fernando Valley Legal Services, can be reached at (800) 896-3203. Its counselors can also help with referrals in neighboring counties. The Orange County Health Consumer Action Center can be reached at (800) 834-5001 or (714) 571-5200.
* Secure Horizons, a Medicare HMO, has a community resource guide available to members at (800) 228-2144. The information is available to anyone through the plan's Web site, http://www.securehorizons.com.
* For seniors and disabled residents who are having problems getting ambulance services paid for, the Center for Health Care Rights in Los Angeles can provide assistance and counseling. The telephone number is (800) 824-0780.