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01-17-2015 07:38 AM
On Thursday afternoon my DH had a small stroke. I took him to the ER and he is going to fully recover. However, they no longer , from what the ER doctor explained to us, admit anyone as a true admission anymore but instead admit you as an observation patient. By medicare rules - until they have a definitive diagnosis they can't actually admit you. The problem with this is --- when you are an observation patient they do not pay 20% of the 80 % they are supposed to pay and neither does your supplement or advantage plan. You - the patient - have to pay it. It took an entire 24 hours before they assigned my DH a diagnosis so we will have to pay our copay of $400 a day for the first 5 days he is in the hospital (I have no issue with that as we knew we signed up for that) + we will have to pay the 20% for the first day + our copay for the ER. I don't know how much it will be but I'm expecting it to run us a few thousand in the end of it all. That extra 20% feels like such a rip off to me. And it is not helping my DH one bit to know he is racking up these bills.
It seems to me that co pays are supposed to prevent people from using the ER inappropriately and I have no issue with that - but it also seems that once a person has a diagnosis that is appropriate - like my DH's stroke - that should be forgiven because, clearly, he did need to come to the ER and be admitted to the hospital for his condition.He was using the ER appropriately.
01-17-2015 09:12 AM
01-17-2015 09:12 AM
this obs rule has been in effect for many years. My father had surgery recently and was expected to stay overnight because his age and the fact that he takes blood thinners puts him at risk. When we met with his surgeon before the surgery, I asked him if his stay would be considered an OBS stay and he said yes, almost everything is anymore. Medicare issued that rule to make people pay more of the cost. It used to be up to 23 hours is not ad admission, but now it is even longer than that.
01-17-2015 10:45 AM
Very sorry about your DH, HH! Glad he's ok. Seems like Medicare is looking for loopholes! I would be upset too! Good thing you were there and recognized the stroke symptoms! That was a God thing!
01-17-2015 10:55 AM
And without a 3 day admission, an observation patient can not be admitted to rehab or a skilled nursing unit. Remember, there is a penalty for readmissions and the hospitals are financially dinged and this ding was strengthened under Obamacare. We can all get mad at Medicare, but the hospitals are working their angle financially to avoid this penalty as well.
I hope your husband gets better. A close family member of mine fell and he was admitted under observation. He ultimately needed rehab and didn't qualify because he was "only" an observation patient. It is a sad situation.
01-17-2015 11:03 AM
I hope your husband has a speedy recovery. Unfortunately, it's not just Medicare that shafts people on ER visits and most people don't find out how expensive it is with insurance until they have to use the ER. There was a time you could see or call your doctor when having symptoms and they would admit you to a hospital without all the ER rigamarole but I don't think that happens now unless your having surgery. My friends in Europe can't believe that people in this prosperous country can lost their life savings with one illness.
01-17-2015 11:30 AM
01-17-2015 11:42 AM
It may be more which hospital you're in than Medicare itself although Medicare does come into play. Still, when I had to go to the ER after fainting twice within minutes in a public place, the hospital kept me in an ER bed even though by paperwork I was an admitted patient. (No beds available except the one I was already in; finally got the cardiologist to say I could leave after 36 hours as long as I agreed to return for more tests.) The bills I paid were not at all exorbitant although I did think some of the charges (before Medicare cut them down) were.
Hope in the end you do as well. I have traditional Medicare plus gap, not an Advantage plan. That may make a difference????
01-17-2015 12:02 PM
01-17-2015 12:08 PM
I'm sorry about your husband. I hope he fully recovers.
Is this something unique to an advantage plan? I remember my mom being hospitalized a jillion times and was admitted under ""observation"" several times and their supplement picked up everything Medicare didn't cover.
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