Changes with how meds are NOT covered during hospital stay?.
Mom has chronic pain from bad arthritis in knees, spinal stenosis, cervical stenosis and hip replacement x3 on same hip. Can't take the opioids and Dr. wants her to try LIDODERM patches...insurance carrier (same one) covered these 2 years ago when we used them for her back...now they won't because it is not medically necessary.
Needed to get new DWO form completed so mom could have albuterol for the nebulizer since she is on her second bought of bronchitis in 6 weeks...the new form (6 calls) actually is required because these meds have been switched from Part D coverage to Part B...then there are two more forms that mom had to fill out and return. Drives me crazy!!
She was in hospital...now they won't let you bring in your own meds but MEDICARE NO LONGER COVERS regular medications if patients are in for diagnosis or observation. Are you kidding??? Medicare tells me I can bill to her part D provider...but they have NO IDEA how to process and the hospital will not bill Part D. OH MY...what a system...
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Or send the form to them for completion and return to you; that puts the onus on them to do the legwork. My feeling is that if they were able to send you a line item bill, they have the documentation, or should have, so it shouldn't be that difficult to pull the specific details from the medical charts.
(But make sure you keep a copy of the form as the hospital may well "misplace" it and just send you another bill.)
Be prepared for a battle though. I'm guessing that the hospital provides meds from a central stock, with pills being dispensed for a number of patients. At this point in time, they probably don't even want to trace back the specific script number.
But go for it - I would in your place. It's outrageous for hospitals to be able to price gouge on medicines.
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I was livid, especially since the hospital staff admitted the overnight stay was due to action they took during surgery, which caused the need for an overnight stay and monitoring.
I took a firm but pleasant posture with the hospital and went as far up the chain of command as I could, reiterating what I had been told was their role in creating the need for overnight monitoring. I read from the notes I took, and caught them trying to squirm out of their liability.
I also appealed Medicare's decision. At the second level of appeal, Medicare asked if we wanted to continue with the appeal. I think they were hoping we would "go away". I advised we intended to carry the appeal as far as we could.
I never heard again from either Medicare or the hospital, which just dropped the charges. Medicare was technically in default of its obligations in handling the appeal since it failed to comply with its stated responsibility in evaluating at the second level.
Part D coverage didn't even factor into the issue as neither of us have it; his costs are so low that Part D would cost more than just the meds, and I have no medication costs on any regular basis.
You can learn more about these issues in the "Medicare and you" 2015 booklet, page 38, in the section "Are you an Inpatient?", and at these links:
http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&script_id=1755
Here's some history and information on the lawsuit filed on this issue:
http://www.medicareadvocacy.org/medicare-info/observation-status/
http://www.washingtonpost.com/national/health-science/medicare-covers-less-when-a-hospital-stay-is-an-observation-not-an-admission/2014/09/08/9c609544-2d5c-11e4-9b98-848790384093_story.html
http://www.medicareadvocacy.org/medicare-info/observation-status/
(I haven't followed the case to learn of any disposition.)
A few months ago I went to the ER after not feeling quite right a few days after having surgery. After the ER I was placed in Observation while the hospital waited for test results. Stayed two nights. It will be interesting to see what I will need to pay on the hospital bill.