Protect Seniors from Medicare Scams

If you’re reading this, you’re probably a senior or have a senior in your life. Did you know that every year, millions of seniors fall prey to scammers and crooks pretending to call from Medicare?

Here are some tips to help you or your loved one avoid these unscrupulous characters:

Medicare does not call beneficiaries

This is the number one piece of information that will help many seniors spot a scam. Medicare, like virtually all government offices, never makes unsolicited phone calls. To make this crystal clear: Unless you called Medicare and are expecting a call back, Medicare will not call you. They send letters if they want to tell you something.

Some scammers will call you, pretending to be from Medicare, and say you have a debt you must pay. Alternatively, they may claim Medicare owes you money and they need your bank account information for a direct deposit. Now, with Medicare replacing all beneficiaries’ insurance cards beginning this April, you may get a call from someone stating you need to pay for the new card. This is false; the card will be mailed to your house and it’s 100% free.

If there really is an outstanding debt, Medicare will mail you a letter about it. Do not let anyone intimidate you into paying your debt right now or they’ll come arrest you. If you get such a phone call, hang up and call 1-800-Medicare (1-800-633-4227) to check.

Don’t give personal information over the phone unless you made the phone call

If someone calls you claiming to be from your doctor’s office or hospital and requests your banking or insurance information, do not give it unless you personally  know the person you’re speaking to. Sometimes these crooks can obtain your health information through illegal means, and sound very convincing. Remember, you have the right to hang up and call your doctor’s office on their regular number and check with the receptionist that the call is legit.

Protect your Medicare card

Medicare advises you to treat your card as a credit card. Don’t leave it lying around, and only give the number to your doctor.

Be aware of Medicare fraud

Some real but unscrupulous companies will bill Medicare under your insurance ID for services you didn’t receive. Never sign for anything you’re not sure is 100% accurate. You have the right to ask your provider exactly what they will bill Medicare and how much your coinsurance is expected to be.

You should also review your or your parents’ explanation of benefits statements regularly. This is the document your insurance company sends you, itemizing the medical services they paid for. Call the insurance company right away if you notice any discrepancies.

If you have an elderly family member living alone, remind them about the possibility of scams. Follow the link below to download a handy print-out you can paste next to your loved one’s phone to help them remember about scams.

Click here: Free Printout for Phone

sample of printout to place near phone



Ambulance Transports and Medicare: What Is and Isn’t Covered

If your loved one requires an ambulance for any reason, you might wonder whether or not Medicare will cover it. Ambulance transports are covered under Part B (outpatient) Medicare, but there are many regulations and limitations surrounding coverage.

It’s important to know your coverage and rights in advance. The best customer is an informed one, and that is especially true in medical care!

So here’s what you have to know about coverage of ambulance transports:

Allowed Amounts

Before we go into the coverage of various types of transports, let’s talk about “allowed amounts” for a minute. Medicare has a capped amount they allow for each ambulance ride, and anything above that amount is the provider’s responsibility.

Medicare covers 80% of the allowed amount. You will be responsible for the 20% coinsurance, unless you have a Medigap plan and/or Medicaid. If you haven’t yet paid your deductible for the calendar year, you will need to pay it before coverage kicks in.

Emergency Transports

Medicare always covers transports for emergencies. When you call 911 during an emergency, the transport to the hospital will be covered at 80% of the allowed amount.

An emergency transport’s Medicare coinsurance is normally around $80. If you have Medicaid or a Medigap (Medicare supplement) plan, they will cover the balance. Many other secondary or supplemental insurance plans will cover the emergency transport coinsurance as well.

Non-emergency Ambulance Transports

Residents of nursing homes are able to see the attending doctor when he makes his rounds in the facility. But if they need to see a specialist—such as a cardiologist or dermatologist—they usually need to go to the doctor’s office. Nursing home residents also sometimes need to go to a hospital or clinic for certain treatments unavailable at their facility.

Usually, residents who need to go out for appointments are able to go by private car or taxi. But if your parent is bed-confined or otherwise unable to ride in a car, he or she will need a non-emergency ambulance transport. Medicare has strict rules about coverage for non-emergency transports.

The ambulance provider must get a doctor’s order affirming that an ambulance is necessary. They must also document the patient’s condition, and may not bill Medicare if the patient did not technically need the ambulance. Medicare automatically denies payment to any claim that does not meet their medical necessity standards.

Medicare also doesn’t cover transports to doctors’ offices. If your mom is at the facility under her Part A stay, the first 100 days of rehab care, the facility must pay for the transport. Otherwise, she will be responsible for the full cost of the transport.

Some secondary insurances will cover routine ambulance transports. If your mom or dad will need an ambulance for an appointment or treatment, check their coverage beforehand. This will help you avoid expensive surprises after the fact.

Repetitive Ambulance Transports

Say your dad is at Regency Heritage in Somerset, NJ, and has weekly wound care treatments at Robert Wood Johnson hospital. If he needs to go via ambulance—the wound location makes it difficult or impossible to sit, for example—Medicare considers that “repetitive transports”or a “frequency.”

Repetitive transports include trips to and from dialysis, chemotherapy, radiation, and wound care. The rules for repetitive transports are even stricter than those of regular one-time ambulance transports. Medicare only pays for trips that were authorized in advance and meet rigorous medical necessity standards. Frequencies that were not authorized or were found afterward to be medically unnecessary are the patient’s responsibility.

Non-medical Transports

Medicare only covers ambulance transports to “covered” locations. These are typically a hospital, the patient’s residence, a skilled nursing facility, or a clinic. All other locations are not covered. If you want to bring your bed-confined parent to a family party, for example, be prepared to foot the bill.

Medicare will also only cover transfers from one facility to another if the second facility offers care unavailable at the first. If you want to switch mom or dad to a skilled nursing facility closer to you, Medicare will not cover that transport.

Mobility Access Vehicles (MAV)

Medicare doesn’t cover non-ambulance transports, even for medical reasons. Trips in private cars, taxis, paratransit services, or any other specialized vehicle will not be covered. Some private insurances will cover transports in certified wheelchair vans.

Be an Informed Customer

If your loved one needs to go by ambulance for a routine appointment, here are some questions you can ask to make sure you won’t be hit with unexpected charges:

  • Does he or she absolutely require an ambulance?
  • Why can’t I take him or her in my car?
  • Did his or her doctor sign a Certificate of Medical Necessity?
  • Were all required authorizations for both Medicare and private insurance obtained?
  • If the transport is to a doctor’s office, will the facility cover the transport?
  • What will my parent’s out-of-pocket cost be?
  • Which company will be transporting my parent? How can I reach them with questions?

If your parent receives a bill you think is too high, or you feel Medicare should have paid for the trip, you have the right to appeal to Medicare. You can also contact the ambulance company and request an explanation for the charge.


Medicare’s Therapy Cap: What you need to know

Now that the exceptions process for Medicare’s therapy cap has expired, therapy patients and providers are wondering what’s next. Medicare’s annual maximum allowance for outpatient rehab is absurdly low. A patient receiving both physical and speech therapy can reach the limit in just one month.


In 1997, Medicare instituted a cap on how much they’d pay for outpatient rehabilitation services per year. Until December 31, 2017, the law included a 2-tiered exceptions process to allow more coverage if Medicare found the services “reasonable and necessary.”  As of today, Congress has not extended the exceptions process, nor have they repealed the cap altogether.  This could theoretically cost patients thousands of dollars in out-of-pocket therapy costs over 2018.

What you should know

Earlier this week, CMS announced that it is holding medically necessary claims exceeding the cap for 20 days. They are not denying such claims outright, in the hopes that something will change in the meantime. If Congress takes no action, the cap will become a “hard cap” — and patients will be responsible for all outpatient therapy above the limit for the rest of the year.

Keep in mind that if you are receiving sub-acute care under Medicare Part A, the cap does not apply. Your inpatient rehabilitation stay covers your required therapies as part of your treatment plan.

If you think the therapy cap may affect you, speak with your therapist to find out more.


Have You Seen Our New Social Media Snippets?

We have been busy here at Regency lately!

With the exceptional reviews we have been receiving from our grateful families, we decided it was high time to create beautiful social media appropriate graphics of our online reviews wherever they appear, which we have been publishing on our social media pages.

These reviews are initially published on Google etc and then we aggregate the reviews and turn them into social media worthy ‘snippets’ for posting to Facebook!!

Take a look at this latest review snippet, which was recently published on Google by a grateful family at Regency Gardens in Wayne and is now additionally and prominently featured as a ‘snippet’ (I couldn’t think of a better descriptive) on our Regency Gardens Facebook Page!


Allergies Triggered By Specific Immune Cells Identified

Allergies triggered by specific immune system cells have been identified by scientists. This will eventually lead to the development of a blood test that will improve treatment.


Allergies Reactions


Allergy reactions result from weak immune responses to benign substances such as mold and peanuts.  50 million Americans suffer from nasal allergies, and approximately 200 die from serious food allergies each year.

Researchers report that they identified a Type-2 helper T-cell (TH2) that shows if  a person has an allergy. These cells display a “signature” that reacts to common allergens such as peanut,  grass pollen, and mold. TH2 cells were present in every person that displayed allergic symptoms. However, they were absent  in persons who displaying no symptoms.

Right now, doctors use skin pricks to test reactions to allergy-causing substances. These tests are inaccurate and consequently treatment is ineffective.

Allergies Testing

Researchers believe these results will eventually lead to identify the exact substance triggering the allergic reaction. Consequently, accurate diagnosis and treatments can be administered.

Current Allergies Medications

Allergy medications are currently a  hodgepodge of general options. They are available as pills, liquids, inhalers, nasal sprays, eye drops, skin creams and injections.  Here is a brief summary of allergy medications and their application.


 Antihistamines block histamine, a symptom-causing chemical released by your immune system during an allergic reaction.

Pills and liquids

Oral antihistamines ease a runny nose, and itchy-watery eyes, hives, and swelling.

 Antihistamines that cause drowsiness include:
  • Diphenhydramine
  • Chlorpheniramine

These antihistamines are less likely to cause drowsiness:

  • Cetirizine (Zyrtec Allergy)
  • Desloratadine (Clarinex)
  • Fexofenadine (Allegra Allergy)
  • Levocetirizine (Xyzal)
  • Loratadine (Alavert, Claritin)

Nasal sprays

Antihistamine nasal sprays help relieve sneezing, itchy or runny nose, sinus congestion, and postnasal drip. Side effects of antihistamine nasal sprays include a bitter taste, drowsiness or fatigue. Prescription antihistamine nasal sprays include:

  • Azelastine (Astelin, Astepro)
  • Olopatadine (Patanase)


Antihistamine eye drops, treat  itchy, red, swollen eyes. These drops have a combination of antihistamines and other medicines.Side effects include headache and dry eyes.  Examples include:

  • Azelastine (Optivar)
  • Emedastine (Emadine)
  • Ketotifen (Alaway)
  • Olopatadine (Pataday, Patanol, Pazeo)
  • Pheniramine (Visine-A, Opcon-A, others)


Decongestants are used for quick, temporary relief of nasal and sinus congestion. They often cause insomnia, headache, increased blood pressure and irritability. They’re not recommended for pregnant women and people with high blood pressure, cardiovascular disease, glaucoma or hyperthyroidism.

Pills and liquids

Oral decongestants relieve nasal and sinus congestion caused by hay fever. Many decongestants, such as pseudoephedrine (Afrinol, Sudafed, others), are available over-the-counter.

A number of oral allergy medications contain a decongestant and an antihistamine. Examples include:

  • Cetirizine and pseudoephedrine (Zyrtec-D)
  • Desloratadine and pseudoephedrine (Clarinex-D)
  • Fexofenadine and pseudoephedrine (Allegra-D)
  • Loratadine and pseudoephedrine (Claritin-D)


Corticosteroids relieve symptoms by suppressing allergy-related inflammation.


Inhaled corticosteroids treat asthma caused by airborne allergy triggers (allergens). Side effects are minor and can include mouth and throat irritation and oral yeast infections.

Some inhalers combine corticosteroids with other asthma medications. Prescription inhalers include:

  • Beclomethasone (Qvar)
  • Budesonide (Pulmicort Flexhaler)
  • Ciclesonide (Alvesco, Zetonna)
  • Fluticasone (Advair Diskus, Flovent Diskus, others)
  • Mometasone (Asmanex Twisthaler)

Skin creams

Corticosteroid creams relieve itching, redness, and scaling.

Side effects include skin discoloration and irritation. Long-term use is dangerous as it results in thinning of the skin and disruption of normal hormone levels. Examples include:

  • Betamethasone (Dermabet, Diprolene, others)
  • Desonide (Desonate, DesOwen)
  • Hydrocortisone (Cortaid, Micort-HC, others)
  • Mometasone (Elocon)