medicare help needed

My wifes mom went to the hospital after falling down. She re-fractured her back and was placed in a room for 4 nites. All they could do was give pain medication, some with an IV. She's a proud old lady and kind of played the severity of her injury down. After the hospital stay, she ended up in a nursing home with her husband who is trying to recover from 7 bypasses. We were told that she didnt qualify for medicare because she was outpatient instead of inpatient. The policies we have are 1. medicare with a 3 nite hospital stay 2. Plan F and 3. Long term care with a 90 day elimination period. Since she didnt qualify we paid the $216.00 per day and we were going to dispute the admission and departure of the hospital stay with medicare but the hospital is saying that they are only charging for 2 nites and eatig the other 2 nites. This makes it so she wouldn;t qualify. So after talking to medicare and the hospital at least a dozen times, Im still not sure what is going on except that we will owe $216.00 a day. If the plans worked the way they intended them to they would be paying 0.

Thanks for any help.
Bill

Medicare is getting very complicated now days. Could be the hospital kept her beyond what is allowed for the diagnosis? and now it has to be a wash.

Contact your state dept. of aging. They may have help available. Here in Pennsylvania it's the Aprise program, that helps people deal with Medicare issues.

I just read something about a patient being hospitalized for observation not being covered by Medicare. If the hospital did code her stay as observation, this could be the problem.
You also might check; http://www.medicarerights.org/

Observation was the code and the hodpital has determind that she doesnt meet medicares requirement for inpatient. She has a fractured back that is not treatable with the exception of pain treatment. Thanks for the link Fred.

Tia said:

Medicare is getting very complicated now days. Could be the hospital kept her beyond what is allowed for the diagnosis? and now it has to be a wash.

Click to expand...

The gov't has a hard enough time running Medicare which covers a small percentage of the population. And now they want to have a National Health Care Program

Observation status .... okay. They have plenty of rules for cost containment.

A friends x-spouse is having surgery in Puerto Rico Friday and the pt has to bring their own linen to the hospital... be thankful.