Judith Stein got a call from her mother recently, reporting that a friend was in the hospital. “Be sure she’s admitted,” Ms. Stein said.
As executive director of the Center for Medicare Advocacy, she has gotten all too savvy about this stuff.
“Of course she’s admitted,” her mother said. “Didn’t I just tell you she was in the hospital?”
But like a sharply growing number of Medicare beneficiaries, her mother’s friend would soon learn that she could spend a day or three in a hospital bed, could be monitored and treated by doctors and nurses — and never be formally admitted to the hospital. She was on observation status and therefore an outpatient. As I wrote last year, the distinction can have serious consequences.
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Thanks for posting this...important to know if you ever have to go to the hospital. But it is just one more example of an issue that the ACA does not address. Common sense would tell you that if a doctor wants you to stay at the hospital that you are admitted no matter how long that stay is. And why do they charge differently based on this rule? It makes no sense to me...just like you are charged one price if you have insurance and another much higher rate if you do not. That should be illegal.
ReplyDeleteI agree, this is a great article and the examples shown are clear to understand and eye opening.
ReplyDeleteI learned something new today.
Everyone needs to know this and they don't! Why doesn't the public know and why aren't the families notified at the time of admittance? We just got a bill for $17,000 for an overnight stay which included all kinds of tests for heart and other. Why doesn't the admitting doctor tell the family? In our case, it was our family doctor. This will be addressed with him this week! We have medicare and Tri-Care for Life as our supplemental which is normally very good coverage. Medicare is denying the coverage and if they deny, then the supplemental coverage also deny's coverage.
ReplyDeleteThis very thing happened recently to my girlfriend at AGH. She had been sick to her stomach for 4 days and went to the ER on a Monday, very hard to see a primary care on Sat or Sun, she was so dehydrated they had to put fluids in through a vein in her neck! They could not stop the vomiting and had already put 2 bags of fluid in at the ER. She was then put in a room under 'observation' status. The worst part is no one told her and now she is stuck with a large Hospital bill to pay.
ReplyDeleteI consider this nothing short of criminal.., and at the extreme least, redefining 'admit'. Yet another example of the greasy sleezy slime American business has become.
ReplyDelete12:53 My understanding is, if they do not give you notification that you will have to pay, and you do not sign an ABN (advanced beneficiary notification) you do not have to pay. That is also a Medicare requirement. Medicare will notify her if she has to pay or not in the denial.
ReplyDeleteJust when you grow old enough to receive medicare .... and you are not as healthy as you need to be to stay on top of all the piles and piles of paperwork .. WHAM! It seems this is just another instance of the vulnerable (children and seniors) being slammed. God bless that person without an advocate. Think I might volunteer to help people navigate health insurance claims. Is there an agency already in place?
ReplyDelete