appts outside of your facility

Bear with me-I have several questions. I work in a 250 bed facilty.We have a staff of former cna's that run our "clinic" The opth, the pod and the dentist all come to us. The clinic co-ordinates transport to all other appointments.We have a 3 vehicle fleet and still often have to call in our local medical transport company to accomodate what seems to me to be a ridiculous number of follow ups...

Can you tell me the size of your facility and how you manage this? We bear the cost for it all -sometimes insurance does pay for the medical transport but often they won't.Family seldom accompany their loved one.We send a driver and a cna on each trip. Do you have a limit on mileage? Do you charge the resident? What happens if a med or treatment is ordered that insurance won't cover? Do you eat the cost? When is it appropriate for someone to say "No more" I have a 98 yr old s/p MI( in HER 40'S) .Never has had a problem since and is now in the later stages of dementia. She is dependent for all adls and no longer recognizes her loved ones.Why is the card still ordering f/u's q 6 months? Sheesh...

I have never seen anything like this in any other LTC. Never have I seen this much back and forthing.We have residents with 6 to 8 consulting physicians and they are always going somewhere and are always stable.Going to live forever....