Tippy Irwin-March 26, 2015
An elderly woman with two broken ankles from a fall! Transport to a hospital where they cast the ankles and advised the person she did not qualify for admission. Really? What is our health care system coming to? Because the woman was not admitted to a hospital stay, any stay at a nursing home will not be paid for by MediCare, but must come from her own pocket. And rehab? That too.
And it gets worse. Think you have been admitted to a hospital? Maybe not. Even if you are in a room on a floor with other patients, even if this is not your first hospital stay and the care seems to be identical to what it was the last time you were admitted, check with the staff to find out if indeed you have been admitted. It may sound a little crazy, but you may discover that in fact you have not been admitted and you are being held on “observation status.” And if you need to be sent to a nursing home for rehab, it is all out of your own pocket. Medicare will not pay. And there is more………. While you are in the hospital receiving medications from the hospital pharmacy, unless you have been fully admitted, MediCare Part D (the drug insurance part of Medicare) will not pay. It will all have to come out of your own pocket at the inflated prices for drugs that the pharmacy is allowed to charge.
And who is making these decisions? Your own physician does not have the final say. The power lies in the hands of the hospitalist.
If you do not like these rules, I would suggest you write to your congressman and let them know. These are federal rules established by the Center for Medicaid and Medicare Advocacy (CMS).