Because I work at SVMC, I frequently get questions from people about aspects of their care. In almost every case, the questions relate to the cost of care and the answers relate to regulations. The hospital’s goals are to provide safe care, follow Medicare’s rules, and make your care as affordable as possible. Here are some of the most common questions and explanations that might be helpful to you:
“Why can’t I bring my own prescriptions from home? I have enough, and they are less expensive.”
One of the rules that makes hospital care expensive is the “no prescriptions from home” rule. Patients are not allowed to use their own medications while they are in the hospital. It’s easy for individuals to confuse one medication for another. Sometimes pills can end up in the wrong bottle. Pills expire.
It is very important to your doctors and nurses that you are taking the right medications and that you are taking them properly. Taking medications improperly can be deadly.
The only way to verify that patients are taking medications as prescribed is through the hospital pharmacy and verified delivery system. Because the hospital pharmacist serves relatively few patients compared with an outside pharmacist and has to comply with a lot more standards, the same medications you take at home are more expensive to prepare while you are at the hospital.
“I was really sick. How come I was only admitted as an observation patient, instead of an inpatient?”
Whether you are admitted as an inpatient, and covered by Medicare, does not depend on how sick you are; it depends on the length of time you require care. Each patient must meet minimum requirements to stay in the hospital. You need to have stayed for a minimum of two midnights to qualify as an inpatient.
This is a Medicare rule. If hospitals disregard the criteria and admits someone unnecessarily or classify a person’s condition incorrectly, the hospital is charged with fraud, face penalties or may even be shut down.
“Why won’t Medicare cover my stay in a nursing home? I was in the hospital, and the doctor said I needed nursing home care.”
Whether Medicare covers your nursing home care is also dependent on the amount of time you spend in the hospital. Again, each patient must meet minimum requirements. Medicare will pay for a Nursing Home stay if the patient has been in the hospital at least 3 nights. Medicare does not count the two nights spent in the hospital under observation toward the three night requirement necessary to pay for nursing home care.
This is another Medicare rule. If hospitals don’t follow the guidelines, and allow someone to stay so they can have the nursing home stay paid for, that is considered fraud.
“What can I do?”
So it seems as if both hospitals and patients are in a bind. Hospitals have to ensure safety and follow the rules. Patients have to figure out how to pay the bills. Is there anything patients can do to decrease the costs? There is.
The best time to prepare for a hospital visit and to avoid surprises about the cost is before you get sick. The first thing you can do is learn more about your insurance. Medicare.gov is a great resource with lots of helpful materials. Also, read your supplemental insurance policy, if you have one. Help is available through the Southwestern Vermont Council on Aging at 1-800-642-5119. The professionals there will review your insurance policy and Medicare, so you can determine what you would likely have to pay for if you are hospitalized.
If you are admitted to the hospital, ask to see your case manager. Case managers are specially trained nurses. They work seven days a week. It’s their job to make plans for your discharge. That includes helping you understand what services will be paid for by your insurance plan and what services you may be responsible for.
If you are worried about paying too much, the case manager can help you explore your treatment options and maybe minimize the expense without affecting the quality of care. For instance, the case manager may have the doctor and pharmacist review your medications to determine if there are any alternatives. If you live close by, you may be able to have the tests and procedures as an outpatient.
Finally, Medicare is a government program. It is controlled by the legislature. And the legislature is, theoretically, controlled by you. Use your vote to direct your lawmakers or get in touch to let them know your experiences as a patient.
If at the end of it all, you are still uncertain regarding your medical bills or if you are having trouble paying, contact SVHC Financial Counselor at (802) 440-4083. Together, we can work to answer your questions and ensure you get the best care and try to minimize the cost to you.
Jennifer Fels, MS, RN, is the director of utilization management at SVMC. For more information, contact Jennifer.firstname.lastname@example.org. “Health Matters” is a column meant to educate readers about their personal health, public health matters, and public policy as it affects health care.