"Hospitals are now being penalized for high readmission rates in the Medicare senior population. So if they don't admit the patient as an inpatient, then there is no readmission liability."
- Senior Patient Advocates President Terry Bay
Few people actually enjoy sifting through medical bills, dealing with insurance companies or reading fine print. But increasingly, when it comes to Medicare, what you don't know could burn you -- and your wallet. Patient advocates say understanding how you're being billed is key if you want to avoid exorbitant fees, especially as Medicare puts more pressure on hospitals.
Catherine Kercher needed an outpatient procedure last spring, but recovery was more painful than expected. She ended up staying at Wyoming Medical Center for two days and two nights. But what she didn't know was she was never admitted as an inpatient.
"About six weeks later I got this bill from the hospital for $1084.10 and I though 'Oh my, I wonder what that's for?'" Some eye drops and medicine that sit at her home and usually cost her about $100 a month weren't covered by Medicare Part D because they came from the hospital's pharmacy.
Senior Patient Advocates President Terry Bay says it's a tricky difference. "Hospitals do not partner with the prescription drug plans and so for the patient there's this hole, or gap if you will, in their coverage because they're not an inpatient, they're an outpatient in the hospital, and they can't get drugs covered by Part D in the hospital," Bay explained.
Bay sees cases like these all the time, and a growing number of them. "Hospitals are now being penalized for high readmission rates in the Medicare senior population. So if they don't admit the patient as an inpatient, then there is no readmission liability," Bay said.
Reading the fine print though, is still the patient's responsibility. Connie Mcmillan, Kercher's mother, was told it was their responsibility to know the laws and the policies. "We encourage their family to be their advocates. We encourage patients to call us to come up to the hospital, because we need to make that determination while they're in the hospital. Once they leave the hospital their status cannot be changed and that will have everything to do with the cost of their visit to the hospital," Bay explained. If you aren't sure -- and even if you think you know -- ask, Bay says.
"I had no other indications that she would be listed as anything but an inpatient," Mcmillan said. She tried to dispute the expense, but it was too late. Kercher's personal physician thought she should have been admitted as an inpatient, but no changes could be made once she was discharged. And almost a year later, she's still making payments on those eye drops.
We asked WMC what their policy is with regards to informing patients of their status, and a representative gave News 13 the following statement: "Wyoming Medical Center makes every effort to inform patients about their healthcare benefits. Medicare regulations are complex and dictate inpatient and outpatient status. Wyoming Medical Center and hospitals across the country are trying to comply with the complicated rules while keeping patients informed of their status."
She adds the hospital does have financial counselors available, and that they encourage patients to educate themselves on their coverage plans.