DH in Hospital under Observation and Medicare Issues

[TrvlBug]

Took DH to ER last night and they kept him overnight for observation and to get meds right. Have heard horror stories about Medicare not covering observation. Does anyone have personal experience with this? Any recommendations? Thanks.

 

[MBAustin]

Sorry to hear about this, TrvlBug. Hope he is doing better today. The issue with Medicare and observation that I'm aware of is that they only cover skilled nursing after a 3 night admission to the hospital (not observation). There may be other issues but this is the one we ran into with DM.

 

[splitwdw]

Trvlbug, I have no experience but hope your husband is feeling better soon.

 

[meierlde]

Observation is covered under part b not part a. If you have a medigap policy that direct expense will be fully covered, but the cost of prescriptions will be under part D. As noted because it is covered under part b the nursing home benefit also will not apply.

 

[pb4uski]

Yeah, that's the game that hospitals play to get more money out of patients.

 

[TrvlBug]

Thank you for the prompt replies and best wishes. DH is in because of Afib + RVR. Last night his heartbeat just went bonkers jumping from 130s to 160s sometimes coming down to the 80/90s. He had Afib and had cardioversions and an ablation 5 years ago. Nothing since until last night. Waiting for a call to pick him up as well as from his cardiologist for an appt. We suspect a pacemaker is in his immediate future.

Good to know about Medicare...didn't remember the nuances and of course, my gray matter is not working at its finest at the moment!

And we have a sick cat at home!

 

[ivinsfan]

Thank you for the prompt replies and best wishes. DH is in because of Afib + RVR. Last night his heartbeat just went bonkers jumping from 130s to 160s sometimes coming down to the 80/90s. He had Afib and had cardioversions and an ablation 5 years ago. Nothing since until last night. Waiting for a call to pick him up as well as from his cardiologist for an appt. We suspect a pacemaker is in his immediate future.

Good to know about Medicare...didn't remember the nuances and of course, my gray matter is not working at its finest at the moment!

And we have a sick cat at home!

Well I think you have a bone to pick with the status of "observation" It seems fairly obvious this should be an admission for a pre existing cardiac problem. I might do a little complaining to the billing/coding department explaining if they care about getting paid they should correct it now.

Hope they have your DH sorted and feeling better soon.

 

[TrvlBug]

Well I think you have a bone to pick with the status of "observation" It seems fairly obvious this should be an admission for a pre existing cardiac problem. I might do a little complaining to the billing/coding department explaining if they care about getting paid they should correct it now.

Hope they have your DH sorted and feeling better soon.

Just talked to DH. I had asked the insurance Q last night and they advised him this morning that everything will be covered under part B. That assumes he doesn't get admitted. The meds are not working and they can't get his heart rate down and stay down. They have no idea what triggered this episode.

They called his cardiologist this morning wanting to do an ablation but were told no and to try beta blockers first. IIRC he had problems with beta blockers during first Afib years ago and kept almost passing out.

The timing of all this just sucks big time.

 

[pb4uski]

Mor info on the subject:
https://medicareadvocacy.org/medica...ignation,actually been admitted as inpatients.

 

[daylatedollarshort]

Just talked to DH. I had asked the insurance Q last night and they advised him this morning that everything will be covered under part B. That assumes he doesn't get admitted. The meds are not working and they can't get his heart rate down and stay down. They have no idea what triggered this episode.

I hope your DH recovers soon. Did he eat or drink anything out of the ordinary before this happened? I used to have heart palpitations. The doctors did all these tests and told me it was normal, but I found out from my own reading magnesium might help. I changed my diet and haven't had any palpitations in the past several decades.

Related article from Harvard: "Low magnesium levels are associated with the development of heart rhythm abnormalities, particularly atrial fibrillation. Not all doctors think of this, so it's terrific that yours did." https://www.health.harvard.edu/hear...can-a-low-magnesium-level-cause-an-arrhythmia

 

[TrvlBug]

I hope your DH recovers soon. Did he eat or drink anything out of the ordinary before this happened? I used to have heart palpitations. The doctors did all these tests and told me it was normal, but I found out from my own reading magnesium might help. I changed my diet and haven't had any palpitations in the past several decades.

Related article from Harvard: "Low magnesium levels are associated with the development of heart rhythm abnormalities, particularly atrial fibrillation. Not all doctors think of this, so it's terrific that yours did." https://www.health.harvard.edu/hear...can-a-low-magnesium-level-cause-an-arrhythmia

Nothing out of the ordinary other than skipping lunch because we were so busy cleaning the house. Got done, had a great 1-1.5 hr phone chat with family and I was getting ready to go out and get some pizza. We both take magnesium and other supplements along with our regular vitamin pill. DH recently recently had blood work done and everything was in the normal range. This is just so out of the blue.

 

[daylatedollarshort]

Nothing out of the ordinary other than skipping lunch because we were so busy cleaning the house. Got done, had a great 1-1.5 hr phone chat with family and I was getting ready to go out and get some pizza. We both take magnesium and other supplements along with our regular vitamin pill. DH recently recently had blood work done and everything was in the normal range. This is just so out of the blue.

What helped me was more veggies, nuts and seeds (less saturated, more healthy fats). There's thousands of phytochemicals in plants that aren't available in supplement form.


ETA: I almost forgot beans. I found big batches of veggie - bean soup with a little protein helpful.

 

[sengsational]

Totally random, but back in the days when I first got interested in health and vitamin e was the rage, I discovered that synthetic tocopherols caused me to have PVC's. I never have them anymore... just for that month or so, 10 or 15 years ago. But my dad had AFib, and it was a constant problem in his waning years...I hope I don't suffer that fate, but we are cut from the same cloth.

 

[TrvlBug]

DH is home now. They managed to get the heart rate down and it's now bouncing between 85 and 115. He sees the cardiologist tomorrow morning. Now I have to learn about the donut hole. One of his meds has a $302 co-pay...ouch!

 

[aaronc879]

Thank you for the prompt replies and best wishes. DH is in because of Afib + RVR. Last night his heartbeat just went bonkers jumping from 130s to 160s sometimes coming down to the 80/90s. He had Afib and had cardioversions and an ablation 5 years ago. Nothing since until last night. Waiting for a call to pick him up as well as from his cardiologist for an appt. We suspect a pacemaker is in his immediate future.

Good to know about Medicare...didn't remember the nuances and of course, my gray matter is not working at its finest at the moment!

And we have a sick cat at home!

Wow, your post about you DH sounds too familiar to my Dad's situation. Years of Afib, multiple cardioversions, ablation, meds that nearly make him pass out, pacemaker. Now he is scheduled to go back in for a different pacemaker in 3 weeks. They won't do the surgery that he really needs because the anesthesiologist refuses to do it because he says my Dad would have a nearly zero chance of making it off the table after 3 hours of general anesthesia. So it's sedative and numbing and a fancy pacemaker and hope for the best. I hope your DH's condition improves.

 

[TrvlBug]

I'm sorry to hear about your father aaron. Praying he makes it through the surgery successfully and the new pacemaker is just what he needs.

DH and the cat are snoozing upstairs .

 

[spncity]

I believe the three-night hospital stay requirement (linked to Medicare paying for rehab in a nursing home) is currently waived due to COVID.

 

[MBSC]

Now I have to learn about the donut hole. One of his meds has a $302 co-pay...ouch!

Don't forget to check GoodRx.

I recently had a person whose new prescription has a $200 copay on their current Part D plan but it's $40 on GoodRx. Best wishes for a speedy recovery.

 

[grasshopper]

Don't forget to check GoodRx.

I recently had a person whose new prescription has a $200 copay on their current Part D plan but it's $40 on GoodRx. Best wishes for a speedy recovery.

Agree try GoodRx, Ms G was prescribed a drug that was tier 3 on our "D" plan. $150 copay, GR price $8.50.

 

[ivinsfan]

GoodRX meds do not count towards your Part D deductible to my knowledge...if that matters to someone...usually not an issue with us.

 

[MBSC]

GoodRX meds do not count towards your Part D deductible to my knowledge...if that matters to someone.

They do not automatically count toward the Part D (or any other plan) deductible but you can submit the receipts to be manually credited toward the deductible. People tend to save the receipts then submit a whole pile of them at once, so they're called 'shoebox claims'.

ETA: Here is the SilverScript Part D claim form as an example.
https://www.silverscript.com/pdf/claim-form.pdf

4) Use GoodRx to contribute to your deductible.

If you purchase a medication with a GoodRx coupon and the drug is covered by your insurance, you may be able to submit your receipt to your insurer and count that towards your deductible. That way, you’ll still be able to take advantage of your insurance coverage later.

This applies to almost all types of insurance plans, including those from private insurers, commercial health exchanges, Medicare and Medicaid. You’ll want to contact your individual provider to find out what information they’ll need from you and how to submit it.

Reference: https://www.goodrx.com/blog/ways-to-beat-your-insurance-copay/

 

[Koolau]

When I went into hosp a few years back, was placed under "observation." Got a few pieces of paper indicating that I might be on the hook for much of the stay - if it exceeded (IIRC) 48 hours. About that time, the friendly - yeah, really - hospital financial folks stopped by. Said "Just a formality. Before you get stuck with the bill, we'll either admit you for treatment or send you home. Relax!" I saw no attempt to stick me with anything. If anything, Hosp was trying to insure that I did NOT get stuck with uncovered charges. YMMV

 

[pb4uski]

If that was the case why didn't they just admit you? Then there would be no question.

 

[TrvlBug]

When I went into hosp a few years back, was placed under "observation." Got a few pieces of paper indicating that I might be on the hook for much of the stay - if it exceeded (IIRC) 48 hours. About that time, the friendly - yeah, really - hospital financial folks stopped by. Said "Just a formality. Before you get stuck with the bill, we'll either admit you for treatment or send you home. Relax!" I saw no attempt to stick me with anything. If anything, Hosp was trying to insure that I did NOT get stuck with uncovered charges. YMMV

The financial people came by the next morning and advised him that all was covered...no unexpected costs. ER docs were in contact with his cardiologist and they finally got him on some meds which brought his heart rate to an acceptable level most of the time. His 2nd ablation is scheduled for the end of the month.

 

[audreyh1]

Promising! Please keep us posted.