Friday, July 21, 2017

Warning! Make Sure You're Admitted!

This is strictly for American readers, but others will get a taste of the grotesqueries of our medical system.

Let’s say you’ve been vomiting for a few days and drag yourself to an emergency room. The doctor says you need IV fluids, so an aide wheels you to a room where you spend the night and most of the next day and then return home, feeling better.

Or you have chest pain. The ER doctor doubts that it’s a heart attack, but he wants to keep you for observation. After two days connected to a heart monitor and getting blood tests, you’re discharged, feeling better.

In both cases you’ll get a bill for at least $5,000, and YOUR HOSPITAL INSURANCE WON’T PAY!! 

Hospital insurance only pays if you’re admitted to the hospital, but remaining in a holding area for a few days or being kept “for observation” is not admission. You’re still an outpatient, so you’d better have good outpatient insurance.

If you’re over 65 and have Medicare Part A (which is free) but have decided to skip Part B (which costs $109 a month) you have no outpatient coverage. Part A only pays for the hospital. If you’re under 65 and have the usual Blue Cross or Blue Shield, you’re largely covered for hospital charges. Depending on the policy you’re willing to pay for, outpatient coverage varies. A lot. 

The solution, when the ER doctor announces that you need to stay for a while, is to ask: “am I admitted or not?”

Of course, you’re probably miserably sick or frightened (if not, maybe you shouldn’t be in an emergency room), so asking about insurance is not a priority. Woe unto you if you don’t.

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