When a patient is
under observation status, Medicare only covers outpatient costs. The beneficiary must pay a co-payment for all
treatments, medications, testing and labs.
As you enter the ER, you are stopped to complete paperwork for your very
ill loved one. Do you read and
understand every document? Probably
not. You are concerned that they are
receiving the best care and quickly!
What you may not know is that the hospital is asking you to sign a
document that says the beneficiary may be under observation services/status
(outpatient) and is responsible for co-payments. This is cost shifting, shifting more of the
cost of medical care to the beneficiary.
ASK if you are an inpatient or an outpatient. It may seem that you are an inpatient because
you are wearing a gown, in a bed and receiving x-rays, treatments, medications
and even having blood drawn. But...that
doesn't mean you are ADMITTED to the hospital as an inpatient. You may even go to a room and stay 3 or more
days...and still not be an inpatient.
ASK your doctor, the case manager and the billing department
if you are admitted as an inpatient or outpatient. ASK the billing office to estimate your out
of pocket costs as an outpatient.
ASK if you are an inpatient and qualify for rehabilitation
under Medicare in a Skilled Nursing Facility.
Have the Skilled Nursing Facility verify you were admitted to the
hospital as an inpatient for three consecutive 24 hour periods and are covered
by Medicare for rehabilitation services.
Otherwise you may be responsible for a huge bill from the rehabilitation
facility.
Ask those in the House of Representatives to support H.R.
1179: Improving Access to Medicare Coverage Act of 2013 and in the Senate to
support S. 569: Improving Access to Medicare Coverage Act of 2013.
Start a conversation with your loved one about the care they
want and need. Discuss the options for
care, how to stay out of the hospital and if they want heroic measures
performed.
Stay tuned for the changes coming to Medicare!
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