Wellness

[Havarti]

I recently learned about this from a friend who was hospitalized for two nights. If they admit you for "observation" it is likely you will pay the whole bill, with no Medicare or supplemental coverage coming to your aid. If you are admitted as an "inpatient" (usually for 3 midnights or more) then Medicare & supplemental insurance kick in their portion for the bill. It seems this is happening to more and more people, so you get stuck paying the whole bill yourself and all those paid premiums are worthless. Most people don’t find out the realization of the internal Medicare & insurance language until they are home and the bills keep coming. They think because they are checked into the approved hospital and getting care they are covered

It seems like it is a dog chasing its tail in circles. Medicare says it is up to how the doctor codes it; the doctor is pressured by the hospital to do what is most profitable whenever possible (which is charging the patient the full amount verses billing Medicare for a reduced amount); the hospital claims it has to follow Medicare’s guide lines and there you go in circles again. Everybody points the finger at someone else while the patient goes broke.

Anyone have any insight on this subject? Any tips on how to be proactive to avoid getting caught up in this invitation to bankruptcy? Thanks in advance for any helpful info.

[dex]

Does this happen only to Medicare patients or any provider?I have not heard this yet but it sure isn't fair if you have insurance and you have a medical problem that your care isn't covered.I thought our new healthcare system was designed to protect us from this sort of thing.

[Havarti]

On 3/25/2015 dex said: Does this happen only to Medicare patients or any provider?I have not heard this yet but it sure isn't fair if you have insurance and you have a medical problem that your care isn't covered.I thought our new healthcare system was designed to protect us from this sort of thing.

I am learning more...it appears they are doing to everyone now, so it does not appear to discriminate. This is apparently part of the new health care directive.

[athenian]

There was a thread on this topic a while ago started by Happy Housewife. It can also affect whether Medicare will pay for a skilled nursing facility after a hospital stay. I guess you must have someone with you to be very firm with the hospital if you are admitted. I think AARP may be working on this problem.

[Daysdee]

I have read this also. I have an excellent supplement, but if Medicare denies a claim you will get zero from the supplement.

[pattypud72]

When my Mom was in the hospital I found out about all of this. What I learned was that Medicare kicks in after you are admitted to the hospital for 24 hours or more. I was told that you have to be admitted for 3 days or more to be approved for a rehab stay. If you are admitted it can change anytime during your stay to observation.. If this happens you need to complain right away. Medicare will still pick up the tab for the hospital stay but not for any medications used during the observation period. This is how they explained it to me.

[Bhvbum]

This is true and old news. Many programs on TV have addressed this. Same for Doctors who you think are hospital employees and in your insurance system but are really contractors and self-employed and therefor NOT in you insurance approved list. My family got hit with huge bill because of this. This is not some new result of any new healthcare, folks have complained for years, now just being heard!

[Daysdee]

Also, Medicare doesn't pay for convalescent home unless you go from a hospital stay of 3 days or more. If you go directly from your home, you pay from day one.

[Anniecamp]

OP, this happened to me. When I posted about it on these BB's, I was greeted with "you don't know what you're talking about", and called a li'ar. Thoroughly mocked.

[Havarti]

On 3/25/2015 Anniecamp said:

OP, this happened to me. When I posted about it on these BB's, I was greeted with "you don't know what you're talking about", and called a li'ar. Thoroughly mocked.

Anniecamp: I am so sorry that happened to you, some people can be so rude when you are just trying to learn something new or share information with others. I have been fortunate to be healthy so far, so I am just learning about this through the experiences of others…and I am shocked at what I am learning.

I just heard about a 40 something gal who had her stay changed to “observation” at 10:00 PM (they woke her up to tell her – without explaining what it meant) on her second night, as it approached midnight which would have qualified as the 3^rd night. She isn’t on Medicare and she would not be going to a nursing/rehab facility from the hospital, but it would change the billing situation for at least part of her stay – causing her to be billed personally. This is just WRONG on all counts!