The TreeceCo Report
By Tony Treece
June 06, 2014
A growing trend that we are seeing in our financial services practice is a need for more education regarding Medicare for our senior clientele. Every month in America over a quarter of a million Americans are turning 65.
Over the next few weeks in our weekly publication we will be detailing tips and pitfalls of Medicare. Whether we are age appropriate for Medicare or not, we have loved ones who are. Being able to be a resource when they have questions will be invaluable.
If you've ever entered the hospital as a patient for any reason, normally the last thing on your mind is the status of your visit. Are you inpatient or outpatient? The New York Times recently had an article about this potentially costly pitfall.
Medicare will pay differently based on what your status is when you are checked into the hospital. If you need additional care afterwards, your status as a patient will also determine how Medicare pays. If you were checked in for observation, Medicare may not pay for
additional care or rehab afterwards.
Medicare Part A will cover patients who are formally admitted with a one-time deductible. Medicare Part B will cover outpatient services, but X-rays or EKGs are normally billed separately. Typically there will be a charge for each of those.
Currently there is legislation in Congress proposing to make any three-night stay in the hospital an actual inpatient stay; thus any remaining nursing home care or subsequent care would be covered under Medicare.
So how do you know what your status is when you go into the hospital? You as the consumer literally have to clarify this. If the doctor cannot tell you, then ask to speak to the hospital case manager.
If you find out that you are being treated under an "observation" status rather than "inpatient," ask for it to change. If the doctor at the hospital cannot or will not help you, call your primary care physician while you are still in the hospital and ask for help.
If you feel you were checked in under the wrong status, the Medicare Advocacy website is the best place to start a complaint.
Of course, when I learned this, I wondered how you as a patient would be able to go through this process while you're fighting whatever serious or even life-threatening condition led you to the hospital in the first place.
I recommend that you have a power of attorney set up. The best time to discuss this is before an issue ever arises. It could be part of your Estate Planning, which we have covered in our most recent newsletters. I cannot emphasize enough how important it is to plan ahead for situations like this, because it can literally cost thousands of dollars.