Wednesday, August 29, 2012

Today's post could save you thousands of dollars!

The single most common reason that people are hospitalized is falling. After a fall, particularly for those of us of the Medicare age group, the patient often needs to spend some time in a rehab facility. We all know that Medicare will pay for the first 20 days of rehab or nursing home care after a 3-day hospital stay. Not so fast! Failing to read beyond this point may cost you several thousand dollars!

Laraine Sickels, 71,  is a retired teacher who lives in the state of Washington. She fell last summer, broke her pelvis in 3 places and was rushed to the hospital on Thursday morning. By the next Monday, she was ready to leave the hospital for a stay at a rehab facility. That's when her bank account began to bleed.

Let's pick up the story as told in a post on the Money magazine/CNN website titled The painful new trend in Medicare.

"For four nights and five days, she had slept in a hospital bed and donned a hospital bracelet while doctors ran tests and prescribed medications. Yet she'd been held under observation, a designation intended for patients who aren't ready to go home but don't need as intensive care as a fully admitted patient does. And with Medicare, observation services don't count toward rehab coverage."

So her 10-day rehab stay cost Sickels $7,027 out of her own pocket. Medicare wouldn't pay a penny toward rehab. Also, since Medicare wasn't paying anything, neither would Medicare supplemental insurance.

"While not commenting on Sickels' case, Joanne Roberts, the hospital's chief medical officer, says it's common for an otherwise healthy pelvis-fracture patient who doesn't have surgery to stay on observation."

"Sickels' story is an increasingly familiar one. Medicare pays hospitals far less for observation than for inpatient stays. As Medicare seeks to cut costs, a growing army of auditors use an automated screening system to second-guess admissions. A hospital that gets dinged commonly loses all its revenue for a stay."

"Spend a night in the hospital for chest pain, and Medicare might pay the hospital $4,100 if you're an inpatient, $1,800 if you're on observation, says Sandra Routhier, a consultant for Panacea Healthcare Solutions. When an auditor rules that an inpatient stay should have been observation, the hospital typically loses the entire Medicare payment."

You really need to read the full story yourself, Click here to get a better understanding of what happened to Sickels and why.

Then, learn how to protect yourself in a similar situation by reading Medicare: Avoid big rehab bills.

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