I’m on Medicare, but I still got stuck with a $25,000 hospital bill

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    • #240948
      • Total Posts: 7,499

      On June 30, 1966, President Lyndon Johnson inaugurated the Medicare program with the promise that “nearly every older American will receive hospital care — not as an act of charity, but as the insured right of a senior citizen.”

      Medicare Part A was designed to provide that “insured right” to hospital care and is available without cost to every 65-year-old person who qualifies for Social Security. Unfortunately, Medicare Part A has a major gap in its coverage. As a senior citizen with Medicare Part A, I fell through that gap. I was diagnosed with prostate cancer, entered the hospital for a radical prostatectomy and spent the following two nights on a general surgical ward. Several weeks later, I was blindsided with a $25,334 bill for my hospitalization. The surgeon’s bill was an additional $4,695 that was not covered by Part A.

      Certain the bill was a mistake, I contacted the hospital billing department to remind them that I had Medicare Part A, and that Medicare Part A pays the cost of hospitalization. “That is correct,” the hospital representative replied. But I hadn’t been “admitted,” I was told; I had been hospitalized as an “outpatient” under “observation status.”

      Since I hadn’t been formally admitted, those expenses weren’t covered by Medicare Part A, which doesn’t cover observation status. I was stunned and incredulous. General anesthesia, major surgery, two nights on a surgical ward and not admitted? My wife and I are both physicians, but neither of us had any clue that this could be the case.



      The hospital as a scammer

    • #240955
      • Total Posts: 3,830

      Supplemental insurance, Medigap, would have paid that, right? He didn’t have supplemental insurance? He and his wife are physicians and don’t know how the fucked up system works? Something is off here. A two physician household and they didn’t buy supplemental insurance? I find that hard to believe.



    • #240956
      NV Wino
      • Total Posts: 5,160

      Yep. That “under observation” term is a killer.

      “As we act, let us not become the evil that we deplore.” Barbara Lee
      “Politicians and pro athletes: The only people who still get paid when they lose.” William Rivers Pitt

    • #240962
      • Total Posts: 502

      What can be done? If you are scheduled to be hospitalized for elective surgery, get a written statement from your surgeon and from the hospital that you will be admitted and not placed under observation status. If you are already hospitalized, and receive notice of observation status, pressure your surgeon to change your status to admitted, although the hospital is not required to agree to it. These strategies might help vigilant patients, but not countless others who will still be left with unaffordable bills.

    • #240963
      • Total Posts: 1,472

      It does not matter.  As long as we have private control of any part of health care, we can be certain of getting the worst care for the most money.  This is an argument that I hope all democratic presidential candidates would trot out at every opportunity.  What is normally trotted out is that if the government takes over health care, it will be terrible.

    • #240993
      • Total Posts: 800

      I agree with @salemcourt. Insurance Companies need to be removed altogether from the equation. They are in Medicare and Advantage and Gap.

      Animals know more than we do.

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