Susan M. Graham, Certifiled Elder Law Attorney, Senior Edge Legal, Boise, Idaho
Imagine, you are hospitalized for three or more days, you were assigned a room, slept in a bed, had many tests and saw various specialists. Then, you were discharged to a skilled nursing facility (a nursing home) for follow-up care. At that time, you were told Medicare will NOT pay for this care because, although you were admitted to the hospital, you were on “observation” status–not admitted as an “inpatient.”
Medicare Part A pays for care in a skilled nursing facility only if the care follows a Medicare Part A covered three-day inpatient stay in a hospital. Three days are counted as three “midnights.”
What can you do? The Center for Medicare Advocacy, Inc. has prepared a “Self-Help Packet for Medicare ‘Observation Status’” that includes fifteen steps to take to change the hospital stay to “inpatient” status.
- Find out your admission status
- Try to get your status changed
- Steps three through fifteen get more and more complex.
This is an increasing problem locally and nationwide. The cost to a Medicare patient for the skilled nursing care can range from $6,000 to over $40,000 for the first 20 days of care. Be careful next time you are admitted to the hospital.