When our client went into the hospital, she knew it was important to find out if she was being treated as an outpatient or if she was admitted. She did ask and was told she was being admitted. After two days of “observation,” (technically outpatient care) she was released and went home. A few days later when her husband picked up the mail, she was in for a big surprise. Her hospital bills were very high as compared to what she had been planning. Prescription drugs that were administered in the hospital (you cannot take your own with you) had totaled almost $300 alone. She was sure there was a mistake.
Numerous phone calls later, she was assured there was no mistake: she had been treated as an outpatient and never “admitted” to the hospital. Not only were her drugs not covered, she was also responsible for hospital services (like X-rays and lab tests). Her outpatient status also would have impacted the cost of skilled nursing if she would have needed these services – luckily she didn’t.
To prevent this type of occurrence from happening to you, make sure you or a loved one find out your status while you are still in the hospital – are you an outpatient or have you been admitted. If it is a combination of the two, remember, you must have three days as an inpatient to qualify for skilled nursing should you require this service. (Medicare Advantage plans may cover skilled nursing without the three-day inpatient requirement – check with your plan.)
In the case illustrated, the patient did ask and it was her doctor’s intention to admit her but he did not officially do so. If she would have discovered this before she left the hospital, she could have contacted her doctor and had her status changed. The end result on her hospital bill and her pocketbook would have been much different.
For more detailed information on how Medicare covers hospital services, visit www.medicare.gov/publications to view the Medicare & You handbook. You can also call 1-800-MEDICARE. TTY users should call 1-877-486-2048.
