A ‘Very Cruel’ Medicare Rule is Costing Seniors Dearly
WASHINGTON, DC – It’s bad enough to be hospitalized. But thousand of seniors across the country are finding their medical problems compounded with financial frustration and large bills because of a Medicare technicality that can cost them dearly.
The problem starts when their doctors want them to go to a skilled nursing facility as an interim, rehabilitative step between the hospital and home. That’s fairly typical when a patient needs to regain strength but no longer requires hospitalization.
But if the hospital has not classified the patient properly for Medicare billing purposes, then Medicare, the government health insurer for seniors, refuses to pay the skilled-nursing bill. Even a short stay costs the patient thousands of dollars.
For Marilyn “Micki” Gilbert, 83, an assisted-living resident at Menorah Park in Beachwood, the bills came to $17,000 after more than four weeks of skilled nursing care. Following a hospital stay of several nights last August after she fell and was hospitalized “with a head broken open and sutures,” as she put it, she expected Medicare to cover her rehabilitative care.
But Medicare administrators refused. The problem was that when the hospital sent the bill to the Centers for Medicare and Medicaid Services, or CMS, for payment, it said that Gilbert was in the hospital for “observation” rather than admitted in the “inpatient” category.
That difference, which is many cases is a technicality, means the difference of thousands of dollars for every patient affected.
“And believe me, at 83, where am I going to come up with that?” Gilbert asked. “I can’t tell you how bad it was. I have spoken with other people who have had this done. When you’re 83, you don’t have that kind of money.”
The problem is a result of Medicare rules that only authorize follow-up, skilled nursing care after a patient has had inpatient hospital care for at least three consecutive days. Even splitting that classification – say, as one day for observation and two for inpatient care – will not satisfy the three-day inpatient requirement, regardless of the fact that the patient stayed and was treated in a hospital the whole time.
