RobbieB
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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I'm surprised you'd make such a comment since the national debt is the ultimate "blow that dough" experience.
I'm not in debt.
Hospital bill for 25k not covered by Medicare
- Thread starter bmcgonig
- Start date
I'm not in debt.
The military industrial complex took over the country during wartime. The medical industrial complex takes over during peacetime.
Medicare is a scam. You pay into the system and you expect benefits. However, there are so many loopholes that you have to sue in court to get your benefits. The medical industrial complex knows that most people can't afford a lawyer so they win. Have you ever asked yourself why Medicare is so complicated? It's by design.
Medicare is a scam. You pay into the system and you expect benefits. However, there are so many loopholes that you have to sue in court to get your benefits. The medical industrial complex knows that most people can't afford a lawyer so they win. Have you ever asked yourself why Medicare is so complicated? It's by design.
gooddog
Recycles dryer sheets
What this thread needs
When this site is at its best, it is providing information from user to user on how to invest, retire, search for a retirement house, and of course...navigating issues like the one in this thread. There have been a lot of examples, and pieces of information in this thread, but what this thread needs is an expert in the field of health insurance to list how all of us prepare and avoid this type of situation. JMO
When this site is at its best, it is providing information from user to user on how to invest, retire, search for a retirement house, and of course...navigating issues like the one in this thread. There have been a lot of examples, and pieces of information in this thread, but what this thread needs is an expert in the field of health insurance to list how all of us prepare and avoid this type of situation. JMO
Joggernot
Recycles dryer sheets
I know of others who had to pay because they had not been "admitted" to the hospital. Always make sure you are formally admitted to the hospital!
Regarding health care insurance, both ACA and Medicare, I think the advice given on this forum is top notch and actionable. Regarding the thread topic link, the situation is one that (probably) affects a few members at most. Post 16 is well informed, and there are other posts with good links. What additional info do you think is needed?
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And the hospital is worse, because not only do you need an expert to defend you against the hospital finance people, you need an expert/advocate to make sure you don't get bad/incorrect care and to make sure they don't inadvertently infect you with a superbug. We're doomed
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...anyone with Medicare, or anyone helping a loved one wade through the maze of receiving hospital care with Medicare, should read the information. One really cute trick used by the hospitals is to "admit" a patient, and then later, without the patient's knowledge, retroactively reclassify the stay as "observation care"...uh...really
This is a really (financially) scary thread to read, but if I understand correctly there is nothing to learn (or am I missing something?) except to get paranoid waiting for the old age to come...
I do not understand the difference between these two classifications: Admission and Observation? Who decides between the two: Doctor or billing? I'm guessing both. Doctors perhaps are under orders from hospital's management to make 'more dough' for the hospital's P&L Statement.
How can we as patients protect ourselves in such a situation? I'm afraid not much especially when you're in pain and drugged already...
Another scary thing I learned on this thread is that supplemental insurance people buy in addition to Medicare doesn't help either if Medicare doesn't accept the charge to begin with. I thought the idea of buying supplemental insurance (I don't know what kind) is in order to cover all the rest of medical expenses that Medicare doesn't cover.
Gee, it's really scary unless one is a multi-millionaire in this country.
isisdave
Recycles dryer sheets
My comments:
1. A radical prostatectomy is NOT an elective procedure -- but it's not generally an emergency. So he had some time to research. But you've probably run into very smart people who don't know what they don't know.
2. Hospitals get dinged by Medicare if too many patients come back for the same problem within 30 days. This is to keep them from doing exactly what was described in the first page of posts here.
3. Since the doctor in the OP wasn't admitted, his was considered an outpatient procedure, and would have been paid under Part B (i.e. 80%). I think it's unlikely that his employer left him hanging for 20% -- I'll bet they had insurance, or self-insured, the 20%, and that part of the tale is missing.
4. Remember that Part B is absolutely necessary unless you're stupidly rich. There are LOTS of VERY EXPENSIVE outpatient treatments. Like 20% of that surgeon's fee, yes, but what about chemo or dialysis or three months of PT after a fall? And it can take up to 15 months to get back on to Part B (specifically if the need arises April 2, you can't apply until Jan 1 and it's effective July 1 of the next year).
1. A radical prostatectomy is NOT an elective procedure -- but it's not generally an emergency. So he had some time to research. But you've probably run into very smart people who don't know what they don't know.
2. Hospitals get dinged by Medicare if too many patients come back for the same problem within 30 days. This is to keep them from doing exactly what was described in the first page of posts here.
3. Since the doctor in the OP wasn't admitted, his was considered an outpatient procedure, and would have been paid under Part B (i.e. 80%). I think it's unlikely that his employer left him hanging for 20% -- I'll bet they had insurance, or self-insured, the 20%, and that part of the tale is missing.
4. Remember that Part B is absolutely necessary unless you're stupidly rich. There are LOTS of VERY EXPENSIVE outpatient treatments. Like 20% of that surgeon's fee, yes, but what about chemo or dialysis or three months of PT after a fall? And it can take up to 15 months to get back on to Part B (specifically if the need arises April 2, you can't apply until Jan 1 and it's effective July 1 of the next year).
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There's a lot to learn, I think.
First, just knowing of this shenanigans, you can call them on it: ask the status. If it's the wrong answer, say you'll go across the street to the other ER that maybe won't be playing that game. And if they pull this trick, shout it from the rooftops. After they tell you you're not getting admitted, open your phone and start a recording, say "Just for the record, I, Jane Doe am in the ER and XYZ hospital on 12/27/2019 and my husband presented with [these symptoms], now hospital personal I'm sitting here with will tell you that he is not being admitted, and explain the reasons why he is not being admitted." Hold the phone out to them. Maybe they'll change their tune. What you're doing there is your bringing a future lawyer into their lives.
Here's one final pleasant thought: just don't pay. If the ER has to treat anyone who shows up, that includes people with outstanding bills, right?
First, just knowing of this shenanigans, you can call them on it: ask the status. If it's the wrong answer, say you'll go across the street to the other ER that maybe won't be playing that game. And if they pull this trick, shout it from the rooftops. After they tell you you're not getting admitted, open your phone and start a recording, say "Just for the record, I, Jane Doe am in the ER and XYZ hospital on 12/27/2019 and my husband presented with [these symptoms], now hospital personal I'm sitting here with will tell you that he is not being admitted, and explain the reasons why he is not being admitted." Hold the phone out to them. Maybe they'll change their tune. What you're doing there is your bringing a future lawyer into their lives.
Here's one final pleasant thought: just don't pay. If the ER has to treat anyone who shows up, that includes people with outstanding bills, right?
JoeWras
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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This is a really (financially) scary thread to read, but if I understand correctly there is nothing to learn (or am I missing something?) except to get paranoid waiting for the old age to come...
I do not understand the difference between these two classifications: Admission and Observation?
Well, there you go. Something to learn. Yes, there is something to learn about the classifications of your case when you walk or are rolled into a hospital.
That is, what is the difference between the two, and the scam that the hospitals are trying to foist on some unsuspecting people.
>>Re dissing Kaiser "....Plus, we get to CHOOSE our doctors and surgeons.">>
It may not be true of all Kaiser HMO plans since those vary by state, but we have moved around CA and been with Kaiser for 40+ yrs. We have had no trouble choosing doctors; we are free to change doctors any time we wish.
We tried another HMO for a couple of years and it was impossible to even FIND a doctor who was accepting new patients in their network, except in a single clinic in the worst ghetto in the city.
As for waiting in emergency, try sitting in a county hospital's ER on a Friday or Saturday night, LOL.
The only times we've had to wait at Kaiser ER is when it wasn't truly life-threatening. When it WAS serious - my spouse's haemorrhagic stroke; my compound leg fracture where the bone broke through the skin - we were seen IMMEDIATELY.
It may not be true of all Kaiser HMO plans since those vary by state, but we have moved around CA and been with Kaiser for 40+ yrs. We have had no trouble choosing doctors; we are free to change doctors any time we wish.
We tried another HMO for a couple of years and it was impossible to even FIND a doctor who was accepting new patients in their network, except in a single clinic in the worst ghetto in the city.
As for waiting in emergency, try sitting in a county hospital's ER on a Friday or Saturday night, LOL.
The only times we've had to wait at Kaiser ER is when it wasn't truly life-threatening. When it WAS serious - my spouse's haemorrhagic stroke; my compound leg fracture where the bone broke through the skin - we were seen IMMEDIATELY.
Old Microbiologist
Recycles dryer sheets
I think he can sue the hospital for obvious fraud. The admitting surgeon would have been completely aware of his admission status and could have corrected it so this is a policy of the hospital to increase revenues.
I am so glad I don't live in the US anymore and it is things like this that re-enforce my decision to retire in Europe. Here in Hungary that same surgery would maybe cost $1,000 total paying cash. The people in the US have gotten used to these kinds of abuses and seem to accept it as normal. Medicine shouldn't be operated as a business the same for education, prisons etc. Some things just need to be paid for by society as the cost of maintaining that same society at humane levels. Somewhere along the way the US has lost sight of why we have government in the first place. Maybe some of that $23 trillion could have been better spent on things like healthcare and universities?
I am so glad I don't live in the US anymore and it is things like this that re-enforce my decision to retire in Europe. Here in Hungary that same surgery would maybe cost $1,000 total paying cash. The people in the US have gotten used to these kinds of abuses and seem to accept it as normal. Medicine shouldn't be operated as a business the same for education, prisons etc. Some things just need to be paid for by society as the cost of maintaining that same society at humane levels. Somewhere along the way the US has lost sight of why we have government in the first place. Maybe some of that $23 trillion could have been better spent on things like healthcare and universities?
teejayevans
Thinks s/he gets paid by the post
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But how do you know? I would not believe some lowly admin.
As MBSC points out, Medicare eligible folks are often advised to take part A and employer insurance which is what this fellow did so he wasn't actually stuck with a $25,000 bill but just his 20% copay.
If he had part B the hospital would have discounted to the applicable Medicare rate which is probably much less than the negotiated rate with his commercial insurance. He would have owed 20% of that unless he had a supplement. On the other hand he would be paying those part b premiums.
The inpatient/outpatient issue involves hospitals trying to maximize their Medicare revenue. I am not sure that individuals patients have much control over this. There is a corporate strategy and you may not have access to anyone empowered to make an exception.
If he had part B the hospital would have discounted to the applicable Medicare rate which is probably much less than the negotiated rate with his commercial insurance. He would have owed 20% of that unless he had a supplement. On the other hand he would be paying those part b premiums.
The inpatient/outpatient issue involves hospitals trying to maximize their Medicare revenue. I am not sure that individuals patients have much control over this. There is a corporate strategy and you may not have access to anyone empowered to make an exception.
Old Microbiologist
Recycles dryer sheets
I worked in hospitals a fair amount of my professional life (while serving in the military) and moonlighted in civilian hospitals. The admission forms you have to read and sign are not easy to understand and often they use numeric codes which is how Medicare is billed. There are some problems in Medicare that the admission and discharge diagnosis (called a Diagnostic Related Grouping code DRG for short) and the DRG's must be identical. There are also minimum testing and procedures mandated by Medicare for a given DRG that must be performed or payment is null and void. That goes onto the hospital if they fail to do the required minimums. I served on the DRG committee for a couple of hospitals where we reviewed charts prior to discharge to ensure that everything met Medicare standards.
The entire Medicare Part A and Part B is a scam on the US. For example, the charges for a DRG are simplified and standardized so minimum treatment means maximum profit. However, outpatient services can be billed at whatever the standardized costs are. These are set by regions. I served for a number of years as a Laboratory Director for a civilian hospital in the Los Angeles region (I was on a break in service while getting a PhD). Most of the laboratory managers were well known to each other and we established pricing more or less together. For example a typical 20 test chemistry analysis costs roughly $1.20 to run including overheads but Medicare will pay $150 for the tests if done out patient. So, every lab manager charged the same prices give or take a few cents. Medicare requires that if Medicare is accepted (hospitals are not required to accept Medicare patients and many do not) it must be the lowest charge and no private or insurance customers can be charged less. So, the outpatient market is very lucrative. When Medicare went to the DRG payment system my lab went from a profit center to a cost center so I made every effort to market our services to doctor's offices and emergency rooms. As an example a patient is going to be admitted for surgery. If the doctor runs the tests in his office and not in the hopsital it is billed out under Part B and the doctor gets a percentage. If it is done in the hospital he gets nothing and hospital only gets a fixed fee for the entire surgical procedure. Thus, doctors will order tests not required and increase their incomes.
We also took on Veterinary testing as well, another very lucrative market not regulated at all. So, if laboratories are any measure of profit then hospitals are making huge profits which go up exponentially for outpatient work. Some of the riches doctors are pathologists who must be on staff to put their names to the lab testing. They might show up for an hour a week to eat a free lunch in the cafeteria but otherwise you rarely see them. Most own commercial regional laboratories and pad their incomes by being the staff pathologists on many hospitals simultaneously. In my case I was a licensed Bioanalyst so could run the laboratory under my own signature but I had on staff a pathologist for tests requiring a pathologist such as frozen sections etc. I was, in reality his boss, but he got the professional recognition. I got the bonuses though.
So, in this case it seems that they are "pushing" even obvious inpatient procedures to out patient billing to enhance profits. It is obvious fraud and punishable if this guy would file a claim against Medicare for fraudulent practices. Sadly, he is a physician and ought to know better but in my experience physicians are the worst businessmen in the world and hopelessly out of depth when it comes to billing practices. Most Hospital administrators have a degree in Hospital Administration (many are nurses who moved up) and most also have MBA's. If you find a hospital with a physician as the administrator it is certainly less well managed in terms of profit. There are conglomerates that buy up smaller hospitals which were failing and rapidly turn them around using nefarious practices such as described here.
The entire Medicare Part A and Part B is a scam on the US. For example, the charges for a DRG are simplified and standardized so minimum treatment means maximum profit. However, outpatient services can be billed at whatever the standardized costs are. These are set by regions. I served for a number of years as a Laboratory Director for a civilian hospital in the Los Angeles region (I was on a break in service while getting a PhD). Most of the laboratory managers were well known to each other and we established pricing more or less together. For example a typical 20 test chemistry analysis costs roughly $1.20 to run including overheads but Medicare will pay $150 for the tests if done out patient. So, every lab manager charged the same prices give or take a few cents. Medicare requires that if Medicare is accepted (hospitals are not required to accept Medicare patients and many do not) it must be the lowest charge and no private or insurance customers can be charged less. So, the outpatient market is very lucrative. When Medicare went to the DRG payment system my lab went from a profit center to a cost center so I made every effort to market our services to doctor's offices and emergency rooms. As an example a patient is going to be admitted for surgery. If the doctor runs the tests in his office and not in the hopsital it is billed out under Part B and the doctor gets a percentage. If it is done in the hospital he gets nothing and hospital only gets a fixed fee for the entire surgical procedure. Thus, doctors will order tests not required and increase their incomes.
We also took on Veterinary testing as well, another very lucrative market not regulated at all. So, if laboratories are any measure of profit then hospitals are making huge profits which go up exponentially for outpatient work. Some of the riches doctors are pathologists who must be on staff to put their names to the lab testing. They might show up for an hour a week to eat a free lunch in the cafeteria but otherwise you rarely see them. Most own commercial regional laboratories and pad their incomes by being the staff pathologists on many hospitals simultaneously. In my case I was a licensed Bioanalyst so could run the laboratory under my own signature but I had on staff a pathologist for tests requiring a pathologist such as frozen sections etc. I was, in reality his boss, but he got the professional recognition. I got the bonuses though.
So, in this case it seems that they are "pushing" even obvious inpatient procedures to out patient billing to enhance profits. It is obvious fraud and punishable if this guy would file a claim against Medicare for fraudulent practices. Sadly, he is a physician and ought to know better but in my experience physicians are the worst businessmen in the world and hopelessly out of depth when it comes to billing practices. Most Hospital administrators have a degree in Hospital Administration (many are nurses who moved up) and most also have MBA's. If you find a hospital with a physician as the administrator it is certainly less well managed in terms of profit. There are conglomerates that buy up smaller hospitals which were failing and rapidly turn them around using nefarious practices such as described here.
Old Microbiologist
Recycles dryer sheets
To be fair to doctors, they usually have the patient's best interests at heart. Medical practice now is more than 50% in billing problems and dealing with bureaucrats over things such as this. It is a moving target and eats lot into a doctor's time. They are now also pushing maximum number of patients per day with maximum time spent per patient. It has become a factory environment with narrowing requirements to maximize profits. Corporate medicine is all about profit and nothing to do with patient's well being. So, if is a balance between the point of care physician and the corporate pencil necked geeks trying to maximize profits for shareholders. It is the same thing happening everywhere in the US. The problems with the 737Max are a symptom of this and the rapidly changing for the worse population statistics. Infant and child mortality are now the worst (by a large margin) of the top 20 western nations. The life expectancy is dropping and is also now the worst among the top 20 nations.The US statistically is on par with 3rd world countries now but has the most expensive medicare system in the world with outcomes that don't match expenditures. This is a serious problem yet the DNC now is listing progressive candidates (who are proposing various single payer systems) as more dangerous than Russia to America. The system is very obviously broken. The problems is not doctors but corporations (and the plutocrats who own them) who now count more than citizens.
Old Microbiologist
Recycles dryer sheets
RetMD21 - Yes, I think you are correct despite the obvious problems. It seems strange that if you spend two nights in a hospital for a medical procedure such as a TURP that logically this must be billed under the DRG system and not the Part B outpatient system. But the rules are made by politicians and they serve a particular set of masters so perhaps it isn't as ludicrous as it sounds. I have seen patients with brain surgery done completely as same day outpatient surgery and sent home the same day without any post-operative care. So, nothing surprises me anymore.
Here in Hungary we have social medicine which I cannot participate in not being a citizen. Everything is free and no copayments at all for the citizens. Each citizen pays a small amount out of their paycheck each month which is roughly $25. Things are austere but fully functional. Yes, you might have to wait for non-emergent procedures. Sometimes there are lines and there are no schedules at all. We must see our family care physician to get a referral for other services and he is generally open 4 hours a day (alternates between morning and evening). We have found if we go later rather than earlier we wait maybe 5 minutes. He often spends a long time chatting so there is no obvious effort to push things along.The cost for an office visit is $20. As we pay cash we have options to bypass the cues for specialized services and they generally charge more around the $50 level. The same clinic doctors man a 24 hour out-patient emergency clinic in the same facility. The cost for that is free.
We have excellent physicians here and they are truly caring people not particularly interested in making a lot of money. I have noticed a recent return of quite a few physicians from the UK, France, and Germany who are happy to be home. Doctors salaries are fixed by the government and are roughly $2500 a month now which is high in Hungary. Specialists have actual research PhD's and most are very well published. All doctors work privately one or 2 days a week in the evenings and often in the same clinic they work in during the day. This is not an unacceptable way to do things. It used to be that you were expected to tip doctors roughly $50 but the government has doubled their salaries and made tipping illegal. So, generally we see doctors privately rather than go to the pubic clinics. The cost to us is the same either way. Many are good friends to us and we socialize with them as I am a colleague.
If you pay cash like we do then they have to try and figure out how to bill the costs which is something they are not set up for at all. For example, my wife had a heart attack last April and spent a week in the National Cardiological Center and the total cost was roughly $1,500 paying cash including the intra-arterial procedures ambulance, diagnostics, in patient care and medications. The Cardiac Institute did set up a fee schedule so they are ahead of the game. With Brexit happening a lot of Brits will no longer have free health care so will have to buy insurance or pay cash. So, establishing fee schedules is going to become normal here. So far they are reasonable. I recall the days before Medicare when costs were far lower. IMHO Medicare is the cause for the massive cost increases in medicine in the US as it was a cash cow for the medical industry and ran completely out of control for years. How to fix it is a real problem.
Here in Hungary we have social medicine which I cannot participate in not being a citizen. Everything is free and no copayments at all for the citizens. Each citizen pays a small amount out of their paycheck each month which is roughly $25. Things are austere but fully functional. Yes, you might have to wait for non-emergent procedures. Sometimes there are lines and there are no schedules at all. We must see our family care physician to get a referral for other services and he is generally open 4 hours a day (alternates between morning and evening). We have found if we go later rather than earlier we wait maybe 5 minutes. He often spends a long time chatting so there is no obvious effort to push things along.The cost for an office visit is $20. As we pay cash we have options to bypass the cues for specialized services and they generally charge more around the $50 level. The same clinic doctors man a 24 hour out-patient emergency clinic in the same facility. The cost for that is free.
We have excellent physicians here and they are truly caring people not particularly interested in making a lot of money. I have noticed a recent return of quite a few physicians from the UK, France, and Germany who are happy to be home. Doctors salaries are fixed by the government and are roughly $2500 a month now which is high in Hungary. Specialists have actual research PhD's and most are very well published. All doctors work privately one or 2 days a week in the evenings and often in the same clinic they work in during the day. This is not an unacceptable way to do things. It used to be that you were expected to tip doctors roughly $50 but the government has doubled their salaries and made tipping illegal. So, generally we see doctors privately rather than go to the pubic clinics. The cost to us is the same either way. Many are good friends to us and we socialize with them as I am a colleague.
If you pay cash like we do then they have to try and figure out how to bill the costs which is something they are not set up for at all. For example, my wife had a heart attack last April and spent a week in the National Cardiological Center and the total cost was roughly $1,500 paying cash including the intra-arterial procedures ambulance, diagnostics, in patient care and medications. The Cardiac Institute did set up a fee schedule so they are ahead of the game. With Brexit happening a lot of Brits will no longer have free health care so will have to buy insurance or pay cash. So, establishing fee schedules is going to become normal here. So far they are reasonable. I recall the days before Medicare when costs were far lower. IMHO Medicare is the cause for the massive cost increases in medicine in the US as it was a cash cow for the medical industry and ran completely out of control for years. How to fix it is a real problem.
JoeWras
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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Like my doctor's office, a good old school guy trying to stay alive as an independent.
But not his competition. All the new megapractices are in offices with gilded halls. Same for the hospitals. People want to feel good going to a "nice place."
Same can be said about college costs, but that's maybe a whole different story... (as I muse about the cost of the beautiful terrazzo floors I saw recently at a community college of ours...)
pb4uski
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I was thinking the same thing... they usually just tell you that you need to stay overnight and that they are moving you to a hospital room.
I guess that you need to know enough to ask whether you are being admitted or kept over for observation and if the latter then object.
That said, they could tell you that you are being admitted and you could find out later that it was only observation... and they could just claim that there was a misunderstanding or miscommunication.
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Old Microbiologist
Recycles dryer sheets
JoeWras - I found it interesting here that they never turn the lights on in the day time in any public buildings. That is apparently what windows are for. There is no air conditioning and everything is sort of "Soviet" style meaning functional but plain. However, everything is clean and serviceable and they have relatively state of the art equipment. The hospital stay itself has minimal nursing staff and meals are really minimal but you are paying $7 (yes, you read it right) a day. Here the family is expected to do the main stuff. All gowns, masks, gloves, booties, for visitors to ICU's are dispensed out of a pay vending machine. It is about $2 for the set so not outrageous and shifts the cost to visitors. There are no private rooms at all so that isn't even an option. My wife got a roll and thin soup for lunch with tea. That was it. The same for dinner. However, there are 3 cafeterias and a MacDonalds across the street so easy enough to get something to eat if you are mobile. If not, the family is expected to feed you. Family is very important here and are expected to participate. It is not an option. If you are alone then you probably will have more attention but it would be an exception. They aren't cold or cruel but just have a different outlook on life and the role of family. You get nurses for the actual medical stuff like TPR's and bandage changes. But bathing, toilet, feeding, bed linen changing etc. that is on you. The US military prior to 9/11 it was the same so not too surprising to me from that perspective. Now things have changed in the US military as well. I remember mopping floors and helping change bedlinen for seriously wounded soldiers on my ward when I was an inpatient after oral surgery back during the Vietnam War. Times change.
If these kinds of things keep costs reasonable then I don't mind it at all. Austerity is sometimes a blessing in disguise. I remember when a corporation bought our community hospital I worked as a technician at. They put in all new carpets, wall coverings, paintings, new beds etc. but the actual medical care didn't change at all and in fact got much worse. But the place looked beautiful so people ignore the actual problems because they perceive the place is good based on appearances. They were blind to the nosocomial infection rate or other signs of poor care. No one noticed that every birth was by cesarian section regardless of the circumstances. These are the kinds of things not obvious to patients. I always say to anyone ask a nurse if they would be a patient there and if they are honest you will get a real assessment of the risks in a particular institution. If they won't go then you know something is rotten in Denmark.
If these kinds of things keep costs reasonable then I don't mind it at all. Austerity is sometimes a blessing in disguise. I remember when a corporation bought our community hospital I worked as a technician at. They put in all new carpets, wall coverings, paintings, new beds etc. but the actual medical care didn't change at all and in fact got much worse. But the place looked beautiful so people ignore the actual problems because they perceive the place is good based on appearances. They were blind to the nosocomial infection rate or other signs of poor care. No one noticed that every birth was by cesarian section regardless of the circumstances. These are the kinds of things not obvious to patients. I always say to anyone ask a nurse if they would be a patient there and if they are honest you will get a real assessment of the risks in a particular institution. If they won't go then you know something is rotten in Denmark.
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It is very strange. - rules not logic
MBSC pointed out that the outpatient stays keep the hospital out of trouble with short admissions and they also benefit the bottom line.
Starting in the 80s the Drg system paid a fixed amount for an admission rather than billed costs. The incentive for hospitals was to reduce the length of inpatient stays but they had to be audited to ensure that they were meeting a minimum standard. When the hospitals got so efficient that the patients were moving in and out fast and hitting the minimum billing criteria Medicare started auditing again and invented the 2 midnight rule so if the patient is expected to be a very short stay they are considered outpatients.
Over 4 decades CMS (Medicare) and the hospitals have been maneuvering over these rules, each trying to get the upper hand. Perhaps eventually outpatient hospital services will be paid by diagnosis rather than by charge and some of the incentive will disappear. Hungary seems to have a better system.
I read that as of Nov. 1, 2019 this kind of billing was illegal but if the info is true, it wouldn't surprise me that hospitals do it anyway. My suggestion is for the OP to contact Medicare.
DH and I have horrible experiences with hospital billing including being turned over to collection for a bill we never received. Recently we received a bill for $34,000.00 because of a doctor's office billing error (Medicare wouldn't pay.). After months of fighting both, the bills have been resolved, but it took vigilance on our parts.
DH and I have horrible experiences with hospital billing including being turned over to collection for a bill we never received. Recently we received a bill for $34,000.00 because of a doctor's office billing error (Medicare wouldn't pay.). After months of fighting both, the bills have been resolved, but it took vigilance on our parts.
The observation is sneaky but it shouldn’t be an issue if you are properly insured ( medicare a and b plus supplement or some kind of private/ work insurance that subs for b and or the supplement, or medicare advantage) unless/ until you are being discharged to a rehab inpatient setting. Then it is critical of the medicare a and b because you need the 3 admitted days to get it paid for.
My experience with medicare advantage plans is that they do not require the 3 days. They want you out of the hospital fast ( they also want you out of rehab fast).
If you happen to end up as an observation patient with regular pre Medicare HMO insurance it might save you money. I had an observation admission through the ED and paid the ED copay which was less than the inpatient admission copayment. The hospital told me this was common
My experience with medicare advantage plans is that they do not require the 3 days. They want you out of the hospital fast ( they also want you out of rehab fast).
If you happen to end up as an observation patient with regular pre Medicare HMO insurance it might save you money. I had an observation admission through the ED and paid the ED copay which was less than the inpatient admission copayment. The hospital told me this was common
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