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You Are Not The One, Maybe

March 24, 2014

Here’s one for the philosophers:  Sometimes You Aren’t Where You Are.  Or rather, you aren’t where you think you are.  Or you’re not where other people think you are.  Or you are, but not really.

This existential state of existence doesn’t only happen in The Matrix.  It happens in Hospitals, The Matrix for people who don’t look like Carrie Ann Moss.  As Ann Carrns discusses in the NYT on March 18, beware of the green and red pills known as “admission” and “observation”.  You think if you spend the night in the hospital you’re admitted, right?  Someone gave you a ticket.  You’re in.  But no.  Turns out if you might very well not be admitted at all, only on observation.  Standing room only, if you will.  Wow.  Lots of mixed metaphors here.

Why should you, the mere mortal, care about what they call your existence?  In the normal world it makes no difference, but in the Matrix of the Hospital and Medicare, it makes a huge difference.  This is because if you are on “observation” status, Medicare won’t cover some stuff that it will cover if you’re “admitted”. Here’s what Ms. Carrns says: (

“Regardless of length, observation stays do not count toward Medicare’s requirement that to be eligible for subsequent rehabilitation services at a nursing home, a patient must have a hospital stay of three consecutive days — three “midnights,” specifically. Otherwise, rehabilitation care may not be covered, making it an out-of-pocket expense.”

OK.  So say you are 80 years old.  You fall and break a couple of bones.  One break is deemed non-operable, maybe a couple of vertebral fractures that don’t effect your spinal cord.  The other gets fixed.  The ER doctor puts you on “observation” status, figuring you’ll only be in the hospital for a few hours, a day max.  You spend three nights in the hospital, waiting for surgery.  The OR board is really busy, the orthopedic surgeon has a bar mitzvah, whatever.  It takes three days.  But you are old, and three days in bed is more than enough to debilitate you, plus your back is killing you.  You tell your friendly social worker that you’d like to go to rehab for a few days.  She will say sure, give me your credit card number.  And you will ask why, since you have Medicare.  And the friendly social worker will say “Well, you weren’t admitted.”  And you will say “I sure the #$%#@ was!”  And she will say “Nope.  You were observation.  Doesn’t count.  Unless you have Medicare Part B.”   So you will say “There’s more than one Part?”  And she will say “Medicare Part A will cover your inpatient stay.  Medicare Part B will cover your outpatient care.  Except for laboratory tests, X-rays, and EKGs”.  And you will say “Wait, I’m not an outpatient”.  And she will say  “Yes, you are, you’re observation status”.  And you will say “Well, change my friggin status to ‘admitted'”.  And she will say “Need a doctor’s order”.  Or something like that.  Then you will have to get congressional approval for a status change.

You could ask for clarification, but this is what you’ll get  (courtesy of Ms. Carrns):

“While the payment for any single Part B service cannot be more than the inpatient deductible, the total of all payments for Part B services may be higher, according to the Families and Healthcare Project of the United Hospital Fund. Prescription drugs are not covered, either. And for those who have chosen not to have Medicare’s Part B coverage, the bills could be quite large. “Each charge is separate,” said Carol Levine, the project’s director, “and it adds up.”

Mhmm.  Clear as mud.  So why wasn’t your 80-year-old self told about your status as “observation”?  Turns out there’s no rule that says anyone has to tell you.    Even the Oracle can’t help you with this one.


From → Health Insurance

  1. johnbennett70 permalink

    This reminds me of my control on my TV. I long for the days when there was ON/OFF. Now there are so many buttons, I don’t even use, and cannot find the on or off buttons easily.
    What does this have to do with complicated re-imbursements? Lack of simplicity. I don’t watch TV a lot because of that stupid control, and maybe that is a good thing. But this lady probably will say, “Give me simplicity, throw her hands up, and hand the credit-card over. I am sure there is a French term for that, to accept simplicity rather than having a brain seizure, trying to figure da friggin thing out.

  2. Bettercareelsewhere permalink

    This is why the govt. should not run medicine. Business people are bad enough. What is the Matrix and who is Carrie Ann Moss?

    • You’re right! Government shouldn’t run medicine. You are hilarious about the cultural references! The Matrix – look for the movie. Carrie An Moss – well, suffice it to say she’s in pretty awesome shape…

      • Bettercareelsewhere permalink

        At the same time, MD’s are not the best admins … 😉 I don’t look at movies or have TV or anything like that. I get together with my sisters once a year (or my coworkers) and they tell me who the Kardashians, and the Ducks – or whoever they are of Duck Dynasty – are. Carrie Ann Moss isn’t a triathlete, runner or swimmer, far as I know. I’m out exercising, reading about eating healthy, and a bunch of other things so that my mind and body are as fit as possible.

        Just what the doctor ordered!

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