Cautionary tale for those on Medicare

On Medicare, but still got stuck with a $25,000 hospital bill

latimes.com/opinion/story/2...

[park_bear]

"Since I hadn’t been formally admitted, those expenses weren’t covered by Medicare Part A, which doesn’t cover observation status. I was stunned and incredulous. General anesthesia, major surgery, two nights on a surgical ward and not admitted? My wife and I are both physicians, but neither of us had any clue that this could be the case."

This is essentially a scam that has been embraced by medical profiteers. Years ago this sort of thing was unheard of.

[ddmagee1 in reply to park_bear]

Absolutely! It’s a nightmare, having to go through, all the financing and Medicare rules!

[Mjm012649 in reply to park_bear]

Total scam!

[LindaP50 in reply to park_bear]

We just learned that Medicare changes their guidelines yearly. Husband was recently in Emergency and then told was being Admitted as an Inpatient. Upon discharge the nurse stated the hospital has us "Admitted as an Inpatient" but when clearing discharge with our Insurance company (medicare advantage) they stated he was Admitted as an "Outpatient under Observation" and reason is Medicare is looking for ways not to pay patients/insured. We haven't gotten the bill from hospital yet. I hope not to faint.

Contacted my insurance rep and he said wait to you get the bill and we'll discuss how to work this out before processing a claim for grievance with the insurance company. Especially since hubby was being treated for a uti which affected his kidneys. There was only a short-time of observation and that was in the Emergency room.

This will be a wait and see but I will fight if need be.

[park_bear in reply to LindaP50]

If there is an insurance company involved it is Medicare Advantage and not Medicare.

Medicare Advantage is NOT the same as Medicare. It is private insurance much more prone to scamming you than government run Medicare.

A friend of mine had Brand X Medicare Advantage integrated with the Brand X medical system. She went to her Brand X regularly scheduled physician appointment debilitated with the flu. Her doctor ordered her to the Brand X ER. They revived her with an IV and insisted on an MRI over her protest. Brand X Medicare Advantage decided the ER visit was "unnecessary" and she received a bill for $19,000. She contacted the state insurance commissioner who got the matter straightened out.

[LindaP50 in reply to park_bear]

Yes, I understand the difference. I'm waiting for the bill to see how much Medicare Advantage will be paying.

[kaypeeoh]

I'm not on medicare...yet. But last year I had 100% obstruction of the LAD, A major artery supplying the heart muscle. Nurses called it, "The widow maker". So when the doc said I needed surgery right away I said OKAY!. Then later found my insurance wouldn't cover the bill because I hadn't checked with them first. The bill was $55,000. By pissing and moaning I only got it down to $49,000.

[Hidden in reply to kaypeeoh]

Did you ask for charity care?

Also, you can appeal the insurance requirements by citing the emergency nature of the procedure. You could argue that you could not have done the prior authorization because you had no time.

[park_bear in reply to Hidden]

And if the insurance company is uncooperative you can take the matter to the state insurance commissioner.

[park_bear in reply to kaypeeoh]

I had a procedure done some years ago that was covered by insurance. The actual insurance payment was a fraction of the stated hospital bill.

[Hidden in reply to kaypeeoh]

Kaypeeoh, even after a year, you can revisit your situation.

[ddmagee1 in reply to kaypeeoh]

What a nightmare!

[LindaP50 in reply to kaypeeoh]

That's sinful. Can you file a grievance? Plus, we as patients don't know what the hospitals, drs and nurses write about our care - sometimes one word is wrong and the insurance company will use that wrong word to avoid paying. Kaypeeoh, dig further - keep investigating.

[condor39]

Our medical system inCanada is far fro m perfect, but no one gets stuck with a bill. We have to wait for procedures which are not urgent, buy=t otherwise our system works well .

[Bluejay874]

Suggest all read The Price We Pay by Marty Makary MD

[mgregor6]

I've signed up for Medicare Part B with a Medicare Advantage plan thru United Healthcare. So far it's been nothing but unpleasant surprises...