Wellness

[ChillyTulip]

On 1/17/2015 millieshops said:

One of the major problems with that whole "observation" mess is that too few people are aware it goes on, and lots of the elderly who might have heard about it forget when they're suddenly in the hospital and their caregivers may not be aware at all of how important it is to make sure that if they're in the hospital for more than a few ER hours, they need to keep asking to be admitted, not kept on an observation status. Yes, mistakes are made, but some of that is just deliberate.

Agree millie. The families are infuriated when they eventually get the bills and see what happened. I'd be furious too if arbitrary bureaucratic rules cost me 10 grand or so for a SNH stay. Many physicians are confused about the ever changing Medicare rules so I feel for the layperson trying to navigate the system.

[Tinkrbl44]

Even if it turns out to be an exercise in futility, I would definitely dispute the claim ...... and INSIST that it be reviewed by a supervisor and write a letter explaning WHY it should be paid.

But, that's me ...... I hate when claims (or portions of claims) are denied.

[RetRN]

You must have a 3 night stay that is inpatient to have rehab/nursing care covered. Medicare has other criteria that must also be met. Times are changing and Medicare is poorly managed at the top. Lots of fraud and abuse.

[Margo Channing]

HH--while you frequently annoy the you know what out of me, I sincerely hope your husband has a complete and quick recovery.

[YorkieonmyPillow]

HH I hope your hubby feels better soon!

[moonstone dunes]

HH, best of health to your DH.

I've only been on Medicare since October, was informed of the "observation" status when I signed on to my plan, with help from an advocate. For 2015 my co-pay for hospital stay has doubled, my Rx has gone up, doctor co-pays have also increased. I have a Medicare HMO plan and pay the $105 per month. The plan I selected has in-network limits. An additional lower-cost plan was offered for 2015 but the network is even smaller and my PCP not a participant.

That Medicare book is a basic guide but there are so many iterations of Medicare + plans out there, I encourage anyone going on Medicare to see if there is a Health Care or related community advocate/agency that can walk them through the options. I was unable to stay on my other ins. plan. Had to go on Medicare.

[Lacey1]

Here, most plans don't want you to go to the ER-it's all urgent care centers. Then, if it's too serious for them-they send you to the hospital. I know if you have an established relationship with your PCP, they can arrange for you to be admitted upon registration.

[Carmie]

I am so sorry your husband has not been well. I hope the new year will bring him better health. The observation vs inpatient care has been going on for at least 10 years or so. Insurance companies force the hospitals to bill this way. If they bill for inpatient care for a non life threatening dx, the whole claim is denied as not medically necessary. If you have Medicare and a traditional supplemental plan to Medicare and Medicare pays 80% your supplement insurance will pay the 20% coinsurance each and every time. The Advantage and HMO plans can leave you responsible for some things that may not be covered. They are usually less expensive to purchase, but you have to be aware of what coverage you are passing up. It has always been true that a 3 day inpatient stay is required before a nursing or rehab stay will be covered by Medicare. Hospitals are aware of this and get precertification from Medicare to allow the patient inpatient care if nursing/rehab will be required. The problem starts if a patient needs more than 20 rehab days. So many people get stuck with BIG bills after the first 20 days. It pays to read your policy before you actually need it.

[Madisson]

HH, I hope your husband makes a full recovery.

My uncle recently had numbness and paralysis in his hand. They went to the ER where he had a CT scan. The doctor there said that he had a minor stroke and sent him home with instructions to see his PCP the next day for more tests. Meanwhile, that night he had a major stroke. Because he was asleep when it occured, he was not able to get to the hospital within that 3 hour period for the clot busting drug to work. Now he is totally paralyzed on his right side.

[lucylover64]

On 1/17/2015 ChillyTulip said:

This is another way for Medicare to say they are holding costs down when in reality they are just covering less and less and taking the money out of doctors, patients, and hospitals pocketbooks.

HH: best wishes for your husband's full recovery. AGREED, ChillyTulip.....including all insurance companies.