Medicare won’t cover you if you’re hospitalized for observation.

Mindy D · ‎05-23-2010

Ray Callahan was having chest pains and thought he could be having a heart attack. He went to the ER at Northwest Medical Center in Margate, FL. He was tested in the ER where doctors found a blood clot. Ray says “They took some pictures and came back and told me I had a large blood clot in my lung and I needed to stay in the hospital.” He stayed in the hospital for three days. When he asked the doctors to go home, according to Ray; “They said ‘no, we need to monitor you and make sure that the blood clot does not get loose and cause further damage.”

Ray had enrolled in Medicare Part A and thought his hospitalization was covered by this. The hospital, instead, billed his work health insurance plan. He called hospital billing and spoke to someone that told him that he was in for observation and that Medicare Part A does not cover hospitalization for observation. He was told he was never technically admitted.

On his hospital discharge papers there was a notice that said “Your physician placed you in the hospital as an outpatient and ordered services, but did not formally admit you as an inpatient. The reason for this notice is that Florida law requires that hospitals notify patients of their outpatient observation status upon discharge because your outpatient status may affect the amount you pay for your hospital services.”

My post is based on an article I read by “NBC6 Responds.” The writers contacted Medicare about this and were told that Medicare Part A does not cover observation and that hospitals have to classify a patient’s stay. Medicare also informed the NBC 6 Responds reporter that if a beneficiary is still employed the emplyer’s insurance is considered primary insurance over Medicare.

My information was obtained from the online article “Man Mistakenly Thought Medicare Would Cover Hospitalization” by Alina Machado. Published Oct. 4, 2019. NBC 6 South Florida

Tyak · ‎01-26-2013

He was in the hospital for 3 days and had not been admitted? That doesn't sound right to me.

haddon9 · ‎03-09-2010

I've heard of this before. When my mother had an accident she had to make sure that she was admitted into the hospital to be covered and it was in Florida.

Kachina624 · ‎03-10-2010

This is but one reason I'm glad I don't live in Florida.

New Mexico☀️Land Of Enchantment

Mindy D · ‎05-23-2010

@Tyak wrote:
He was in the hospital for 3 days and had not been admitted? That doesn't sound right to me.

It’s all in the words and codes the hospital uses to classify your stay. If you are taken into the hospital terms Observation, and Admitted are different. This man’s ER doctor could have written Admit for treatment for blood clot and he would have been considered admitted. Instead, the ER doctor wrote observation. Ridiculous, but that’s how things work right now.

Mindy D · ‎05-23-2010

@Kachina624 wrote:
This is but one reason I'm glad I don't live in Florida.

This admitted versus observation is national. Only the disclaimer included on the hospital discharge paper is a Florida thing.

lovesrecess · ‎03-14-2010

Medicare is never the primary insurance unless it is all you have. DH just got his Aetna advantage plan update for the coming year. It says he has to pay $325 per day for hospital stays up to three days. Medicare pays from five to seven, but he still has to pay $50 per day. Still don’t know where the “ advantage” is yet...

lovesrecess · ‎03-14-2010

It’s all about the coding! It has to be coded a certain way before they cover anything at all, not just in Florida.

millieshops · ‎03-09-2010

A few years back - maybe as long as since 2012, there have been warnings we should make sure we are "ADMITTED" to the hospital, but I don't remember thetiming details. I should know that - can't imagine anyone else in my life would be thinking about that!