Posted on March 19th, 2010
Does the following scenario sound familiar?
You have recently been hospitalized. After getting home you receive a bill for a lot more than you have ever been charged before. You call the hospital, the billing department gives you some explanation about not being an inpatient (what?!), that you were “probably” told at the time you arrived at the hospital (I don’t know! I was too busy being sick to listen intently!), that you “most likely” received a patient’s bill of rights or some other document telling you the difference between outpatient and observation admission, and that you have the right to appeal if you do not agree with this decision (good because I don’t agree with having to pay this bill!).
You look through your hospital papers, you call Medicare (and wait for an hour to talk to someone), and you are given the same information that the hospital’s billing department gave you. Now you are really confused as to what you should do, but you know you shouldn’t have to pay this hospital bill!
A client of mine experienced what I have just described and we decided to appeal. Following is the appeal I wrote on her behalf:
Click to see Medicare Letter
The appeal was denied.
The next time you or a loved one is sent to the hospital, listen carefully for the word “observation.” What this means is that Medicare Part A pays for the room and board, Medicare Part B pays for approved therapies and prescriptions (and very few drugs are covered under Medicare Part B). Some insurers will allow you to re-file your prescription charges under your Medicare Part D plan which leaves you liable only for deductibles and copays. But you must be aware of your rights and what you need to do to receive this additional coverage.
There’s more to this conundrum. I’ll blog about it in the near future.
