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Recognized Social Butterfly
Posts: 923
Registered: ‎01-02-2012

Re: Under ‘Observation,’ Could Mean Big Bills

[ Edited ]
Message 1 of 8 (315 Views)

john258 wrote:

byrondennis wrote:

nyadrn wrote:
Under ‘Observation,’ Some Hospital Patients Face Big Bills

 

That means hundreds of thousands of people, Ms. Niemi among them, will be eligible to join the suit against the Centers for Medicare and Medicaid Services, with a trial expected next year. If the plaintiffs prevail, they’ll be able to appeal their observation-outpatient stays.

 


This New York Times article referenced in chrono comment 1 is highly misleading. The good news is that you will probably never care because the odds of you being affected by this breathlessly written blah blah are very small. Specifically the operative word in the NYT headline is “some” (in chron comment 1, the operative word is "could"). Although “some” is technically accurate, the number of or percent of total Medicare beneficiaries that would be negatively affected if “illegally” observed vs. admitted is relatively small in number (certainly not the "hundreds of thousands" claimed) and miniscule as a percent.

 

  • 1. When observed (and therefore covered by Part B of Medicare), typically the beneficiary’s out of pocket responsibility is less than if he or she had been admitted and subject to the Part A deductible.
  • 2. And even all that is irrelevant because 98% of us on Medicare have some kind of secondary, tertiary or more real mostly private insurance because Medicare itself is such lousy insurance and has all the crazy rules described in the article. That secondary, tertiary or more mostly private insurance would pay the hospital any deductible/co-pay associated with either A admission or B observation
  • 3. Further only a small percent of people on Medicare leaving a hospital after either admission or observation need a skilled nursing facility (SNF). So now we’re talking about a small percent of a small percent being affected by the situation described in this article (see Note). Even then, a third of us on Medicare use public Part C health plans to supplement our Parts A and B and in general face none of the crazy SNF rules mentioned in the article. In general, Part C health plan sponsors want to get us into a SNF ASAP if we in fact need skilled nursing.

 

Sorry but all much ado about nothing (again, unless the author wants to point how bad Medicare would be if applied to “all).

 

Note: But this lady kept under observation for six -plus weeks – who clearly was not a retired healthcare insurance agent or she would have known points 1-3 above -- should get an attorney and sue the doctors who kept her in acute care for 39 days. On the other hand, I’m guessing there’s more to that story.

________________________________________________________________________________

What you say is very misleading, and there is a problem in this area. It has been covered all over the US and people need help from experts with it. The one thing all agree on is that a Hospital should clearly explain what they are doing, and why they are doing it to the person, and their guardian since most are elderly. The people leaving a hospital who do need  one usually have a major problem. I had a sister who went through this. Medi Care does not pay for long term care. A person must meet Medicare standards for recovery to remain in a recovery program other wise they are discharged and have to find an assisted living home for care. That means Medicaid. I watched this happen to my sister. Luckily her son was a lawyer and was able to make sure she got the help she needed. That is not the case for a lot of people, and only an expert should  give advice in this area. Medicare is a good working medical insurance program and serves people well most of the time so your comment show that you need to learn about the full program. I say again a person needs an expert to help them, and Hospitals must be open and clear on this subject as the Patient can face big bills they did not expect. It was not to long ago you gave me advice on a medical subject, and if I followed it I would be out over $1,000 per year of needless costs.



I typically do not repost a complete previous comment (especically one that seems to be a complete repost of something I originally posted) but I cannot follow the stream of conciousness technique of chrono comment 7. My comment (chrono 6), as are almost all my comments on this Topic, is based on government statistics. The government statistics about and government rules of what is covered by Parts A, B and C of Medicare are what they are. If you don't believe them... so be it.

 

As for some advice the person who wrote chrono comment 7  supposedly got from me, I cannot imagine what he or she is talking about. I typically post statistics and references to Medicare documents. If I ever post something other than statistics that that someone might consider advice, the advice is almost always

 

  • "Go see the Medicare volunteer at the nearest senior center or like facility"
  • or
  • "Read page such and such in "Medicare and You.""

 This is the 2017 version, which came out in September 2016. 2018 version should be in your mailbox soonThis is the 2017 version, which came out in September 2016. 2018 version should be in your mailbox soon

So either chrono commenter 7 has a reading comprehension issue or chrono commenter 7 is.... (well, either way, it's a reading comprehension problem). There is no advice in my comment (chrono comment 6) nor is there any advice other than the two bullets above in almost any comment I ever post on this Topic.

Valued Social Butterfly
Posts: 5,550
Registered: ‎07-20-2010

Re: Under ‘Observation,’ Could Mean Big Bills

Message 2 of 8 (403 Views)

byrondennis wrote:

nyadrn wrote:
Under ‘Observation,’ Some Hospital Patients Face Big Bills

 

That means hundreds of thousands of people, Ms. Niemi among them, will be eligible to join the suit against the Centers for Medicare and Medicaid Services, with a trial expected next year. If the plaintiffs prevail, they’ll be able to appeal their observation-outpatient stays.

 


This New York Times article referenced in chrono comment 1 is highly misleading. The good news is that you will probably never care because the odds of you being affected by this breathlessly written blah blah are very small. Specifically the operative word in the NYT headline is “some” (in chron comment 1, the operative word is "could"). Although “some” is technically accurate, the number of or percent of total Medicare beneficiaries that would be negatively affected if “illegally” observed vs. admitted is relatively small in number (certainly not the "hundreds of thousands" claimed) and miniscule as a percent.

 

  • 1. When observed (and therefore covered by Part B of Medicare), typically the beneficiary’s out of pocket responsibility is less than if he or she had been admitted and subject to the Part A deductible.
  • 2. And even all that is irrelevant because 98% of us on Medicare have some kind of secondary, tertiary or more real mostly private insurance because Medicare itself is such lousy insurance and has all the crazy rules described in the article. That secondary, tertiary or more mostly private insurance would pay the hospital any deductible/co-pay associated with either A admission or B observation
  • 3. Further only a small percent of people on Medicare leaving a hospital after either admission or observation need a skilled nursing facility (SNF). So now we’re talking about a small percent of a small percent being affected by the situation described in this article (see Note). Even then, a third of us on Medicare use public Part C health plans to supplement our Parts A and B and in general face none of the crazy SNF rules mentioned in the article. In general, Part C health plan sponsors want to get us into a SNF ASAP if we in fact need skilled nursing.

 

Sorry but all much ado about nothing (again, unless the author wants to point how bad Medicare would be if applied to “all).

 

Note: But this lady kept under observation for six -plus weeks – who clearly was not a retired healthcare insurance agent or she would have known points 1-3 above -- should get an attorney and sue the doctors who kept her in acute care for 39 days. On the other hand, I’m guessing there’s more to that story.

________________________________________________________________________________

What you say is very misleading, and there is a problem in this area. It has been covered all over the US and people need help from experts with it. The one thing all agree on is that a Hospital should clearly explain what they are doing, and why they are doing it to the person, and their guardian since most are elderly. The people leaving a hospital who do need  one usually have a major problem. I had a sister who went through this. Medi Care does not pay for long term care. A person must meet Medicare standards for recovery to remain in a recovery program other wise they are discharged and have to find an assisted living home for care. That means Medicaid. I watched this happen to my sister. Luckily her son was a lawyer and was able to make sure she got the help she needed. That is not the case for a lot of people, and only an expert should  give advice in this area. Medicare is a good working medical insurance program and serves people well most of the time so your comment show that you need to learn about the full program. I say again a person needs an expert to help them, and Hospitals must be open and clear on this subject as the Patient can face big bills they did not expect. It was not to long ago you gave me advice on a medical subject, and if I followed it I would be out over $1,000 per year of needless costs.


Recognized Social Butterfly
Posts: 923
Registered: ‎01-02-2012

Re: Under ‘Observation,’ Could Mean Big Bills

[ Edited ]
Message 3 of 8 (419 Views)

nyadrn wrote:
Under ‘Observation,’ Some Hospital Patients Face Big Bills

 

That means hundreds of thousands of people, Ms. Niemi among them, will be eligible to join the suit against the Centers for Medicare and Medicaid Services, with a trial expected next year. If the plaintiffs prevail, they’ll be able to appeal their observation-outpatient stays.

 


This New York Times article referenced in chrono comment 1 is highly misleading. The good news is that you will probably never care because the odds of you being affected by this breathlessly written blah blah are very small. Specifically the operative word in the NYT headline is “some” (in chron comment 1, the operative word is "could"). Although “some” is technically accurate, the number of or percent of total Medicare beneficiaries that would be negatively affected if “illegally” observed vs. admitted is relatively small in number (certainly not the "hundreds of thousands" claimed) and miniscule as a percent.

 

  • 1. When observed (and therefore covered by Part B of Medicare), typically the beneficiary’s out of pocket responsibility is less than if he or she had been admitted and subject to the Part A deductible.
  • 2. And even all that is irrelevant because 98% of us on Medicare have some kind of secondary, tertiary or more real mostly private insurance because Medicare itself is such lousy insurance and has all the crazy rules described in the article. That secondary, tertiary or more mostly private insurance would pay the hospital any deductible/co-pay associated with either A admission or B observation
  • 3. Further only a small percent of people on Medicare leaving a hospital after either admission or observation need a skilled nursing facility (SNF). So now we’re talking about a small percent of a small percent being affected by the situation described in this article (see Note). Even then, a third of us on Medicare use public Part C health plans to supplement our Parts A and B and in general face none of the crazy SNF rules mentioned in the article. In general, Part C health plan sponsors want to get us into a SNF ASAP if we in fact need skilled nursing.

 

Sorry but all much ado about nothing (again, unless the author wants to point how bad Medicare would be if applied to “all).

 

Note: But this lady kept under observation for six -plus weeks – who clearly was not a retired healthcare insurance agent or she would have known points 1-3 above -- should get an attorney and sue the doctors who kept her in acute care for 39 days. On the other hand, I’m guessing there’s more to that story.

Valued Social Butterfly
Posts: 8,617
Registered: ‎08-18-2008

Re: Under ‘Observation,’ Could Mean Big Bills

Message 4 of 8 (519 Views)

ReTiReD51 wrote:

The “Medicare Outpatient Observation Notice” (MOON) has to be given patients within 24 hours if you’re in outpatient observation status.

 

Inpatient or outpatient is a complex decision for your Doctor or hospital to make. There is a big difference in Part A and Part B hospital charges plus penalties for readmission. Making the right call is key to Medicare solvency but on the on the contrary it should be fair to the patient too.

 

Here’s the rules so far ………

https://www.medicare.gov/what-medicare-covers/part-a/inpatient-or-outpatient.html


Like I said, I hope those ( patient/beneficiary or designated other) with the power to sign and acknowledge the "MOON" Medicare document, understand all of its consequences.  

 

Just as before, before the MOON notice, people did not know how the "observation" status affected their following rehab care if such occurred.

 

Fair to patients/beneficiaries -'HA !!!

Many are old and alone or their designated other hasn't been educated on the many nuances within Medicare like the "3-past midnight" or the "observation" ones.

There should be no difference in these different statuses - care is no different - only a label or a timing method - each have been designed to save Medicare money and IMO, are affecting beneficiaries and their care.

 

Recognized Social Butterfly
Posts: 837
Registered: ‎09-03-2011

Re: Under ‘Observation,’ Could Mean Big Bills

Message 5 of 8 (539 Views)

The “Medicare Outpatient Observation Notice” (MOON) has to be given patients within 24 hours if you’re in outpatient observation status.

 

Inpatient or outpatient is a complex decision for your Doctor or hospital to make. There is a big difference in Part A and Part B hospital charges plus penalties for readmission. Making the right call is key to Medicare solvency but on the on the contrary it should be fair to the patient too.

 

Here’s the rules so far ………

https://www.medicare.gov/what-medicare-covers/part-a/inpatient-or-outpatient.html

Valued Social Butterfly
Posts: 8,617
Registered: ‎08-18-2008

Re: Under ‘Observation,’ Could Mean Big Bills

[ Edited ]
Message 6 of 8 (580 Views)

It's not like this problem hasn't been around a while.

KHN July 2015'- Congress Overwhelmingly Approves Bill Bolstering Medicare Patients Hospital Rights

 

Legislation to practicality sure takes awhile

KHN. March 2017 - By Law, Hospitals Now Must Tell Medicare Patients When Care is "Observation" Only

 

Hope those who have the power to sign read and understand its meaning.

Valued Social Butterfly
Posts: 8,617
Registered: ‎08-18-2008

Re: Under ‘Observation,’ Could Mean Big Bills

Message 7 of 8 (583 Views)

Florida beneficiaries are also joining in the fight.

Naples News 08/14/2017 - Lawsuit Aims to Give Medicare Seniors Rights On Hospital Stays

 

They would probably be enough in that state alone to form a huge class.

Respected Social Butterfly
Posts: 35,634
Registered: ‎02-27-2008

Under ‘Observation,’ Could Mean Big Bills

[ Edited ]
Message 8 of 8 (602 Views)

 

Under ‘Observation,’ Some Hospital Patients Face Big Bills Photo
 
CreditDavid Plunkert 

In April, Nancy Niemi entered Vidant Medical Center in Greenville, N.C., with cardiac problems. She stayed four nights, at one point receiving a coronary stent.

Then she went home, but felt faint and took several falls. Five days later, her primary care doctor sent her back to the hospital. This time, her stay lasted 39 days while physicians tried various medications to regulate her blood pressure.

Though they eventually succeeded, Mrs. Niemi, 84, a retired insurance agent, had grown so weak that she could no longer walk.

“They said, ‘She really needs to go to a skilled nursing facility for physical therapy,’” recalled her son Tom Krpata, 63, who’d come from his home in Holliston, Mass., to be with her.

He agreed, but soon learned one of the brutal truths of Medicare policy: Patients can be hospitalized for days, can undergo exams and tests, can receive drugs — without ever officially being admitted to the hospital.  

Instead, they’re “under observation,” which means they’re outpatients, not inpatients. That can bring financial hardships — including lack of coverage for subsequent nursing home care.
 
 

That’s why Mrs. Niemi, on observation status through both hospital stays except for one night, had to pay for rehab herself. “By declaring her an outpatient, they really took away her Medicare benefits,” Mr. Krpata said.

Patients can appeal virtually any other claim that Medicare denies. But there’s no way to appeal observation status. Even Mrs. Niemi’s congressman, contacted by her family, couldn’t help.

But a recent ruling in a case that’s bounced through the courts since 2011 may be a harbinger of changes to come.

On July 31, a federal judge in Connecticut certified a class in a class-action lawsuit: all Medicare recipients who’ve been hospitalized and received observation services as outpatients since January 1, 2009.

That means hundreds of thousands of people, Ms. Niemi among them, will be eligible to join the suit against the Centers for Medicare and Medicaid Services, with a trial expected next year. If the plaintiffs prevail, they’ll be able to appeal their observation-outpatient stays.

https://www.nytimes.com/2017/09/01/health/medicare-observation-hospitals.html?rref=collection%2Ftime...

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