Margie’s mother is rushed to the hospital by ambulance– she fainted in the lobby of her apartment building. She is seen by a doctor, tests are ordered and two days later she is moved from the emergency room area to a hospital room.
When Margie arrives at the hospital, she asked the floor nurse this question:
Is Mom ADMITTED to the hospital or is she here for OBSERVATION?
The answer – for observation. Several visits later to the corporate office, she finally got it changed to admitted status. But it was not easy.
IMPORTANT – If Medicare is involved, asking this can save you thousands of dollars!
Here’s why. If you are at the hospital for observation – even if you have a room and are getting treatment – and you then need to go to a nursing home for rehabilitation, MEDICARE WILL NOT PAY.
The reason – you have not met the minimum requirement of a three-night hospital stay as an admitted patient.
Margie learned about this situation when a friend was scheduled to have both knees replaced at the same time. Initially, she was planning to go to a nursing home for physical therapy for several weeks following the surgery. Then her doctor’s office notified her that she would be returning directly home instead.
The reason: Medicare would not pay for the nursing home rehab because she was going to be in the hospital under observation status for 23 hours – even though she was having surgery. And it is not just short stays that are impacted by this. Another person was in the hospital for 10 days but was never officially admitted.
This is more important than ever. In a nationwide study of Medicare claims by Brown University, the ratio of observation patients to admitted patients rose by 34% in a two- year period. As millions of baby boomers are aging and will need care, hospitals and Medicare will be continually seeking ways to reduce costs.
This important warning is from:
Charlie McClure
Licensed Insurance Agent
Senior Specialist in Long-Term Care Solutions
12028 Deacons Croft Lane
Tampa, FL 33626
Phone: 813-293-0787
Fax: 615-369-8774
