Medicare prescription Part D

[JoieN804109]

Has anyone encountered a hospital stay that the hospital billed insurance as observation stay?

this happened to us and certain medications administered as hospital observation (vs admitted hospital) does not fall under Part D.  I was told I had to submit those charges directly to my part D.  The hospital cannot bill part d.  I did this (I was provided the charges from hospital only after I paid the bill)I sent to part d and out of $300 plus bill, they paid less than $10.

any comment or help

[GailL1]

Medicare.gov - Prescription Drug Coverage (Outpatient)

Since you didn’t give any specifics then this response is pretty general.  Like were these meds some that you normally take at home and just did not have them with you at the outpatient procedure?  If not, why were they given to you in this outpatient setting?

If these drugs were on your Part D plan formulary, then the Part D plan is only gonna pay what is described in the plan for these drugs regardless of where you ge them and the cost is more.  

Again, the purpose of the med is important 

This link should answer your questions -

If not, come back and ask more - 

Excerpts From the link ~. I am NOT copying and pasting all that is at the link, there could be more that applies to your situation.  So reference it - 

• Self-administered drugs in hospital outpatient settings: Under very limited circumstances, Medicare may pay for some self-administered drugs if you need them for the hospital outpatient services you're getting.

Your Cost  In Original Medicare

• If the Part B-covered drugs you get in a hospital outpatient setting are part of your outpatient services, you pay a copayment for the services. Part B doesn't cover "self-administered drugs" in a hospital outpatient setting. "Self-administered drugs" are drugs you'd normally take on your own.
• If you get prescription drugs that Part B doesn’t cover in a hospital outpatient setting, you pay 100% for the drugs, unless you have Medicare drug coverage (Part D) or other drug coverage. In that case, what you pay depends on whether your drug plan covers the drug, and if the hospital is in your plan’s network. Contact your plan to find out what you pay if you get drugs in a hospital outpatient setting that Part B doesn’t cover.

Things to know

Medicare drug coverage (Part D) covers drugs Part B doesn't cover. If you join a Medicare drug plan, check your plan's drug list (also called a formulary) to see what outpatient drugs it covers.