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Medicare billing costs seniors thousands


After a fall in 2012, 81-year-old Dolores Chambers of Centerville was shocked to find out she was being billed for more than $41,000 in hospital charges that she had assumed would be covered by Medicare.

“We were very distressed,” Chambers recalled after showing her son the bill. “I kept telling everybody I will die in poverty.”

Chambers stayed in the hospital for six days, underwent two plastic surgeries and 24-hour heart monitoring. But because the hospital designated her stay as observational rather than admitting her as an inpatient, her stay was not covered by Medicare.

“Under current Medicare policy, a beneficiary must have an 'inpatient' hospital stay of at least three days in order for Medicare to cover post-hospitalization skilled nursing care. Patients that receive hospital care on 'observation status' do not qualify for this benefit, even if their hospital stay lasts longer than three days," according to Sen. Sherrod Brown, D-Ohio.

On Tuesday, Brown visited the Bethany Village senior living campus, where Chambers, resides to raise awareness about Medicare billing and draw attention to a bill he’s promoting to address the issue.

The Improving Access to Medicare Coverage Act would allow for the time a patient spends in the hospital under observation to count toward the three-day minimum for coverage of skilled nursing care at the hospital. It would also create a 90-day appeal period for patients who had a qualifying hospital stay but were denied coverage of skilled nursing care dating back to Jan. 1, 2013.

“Recovering seniors shouldn’t have to choose between getting care and not getting care based on this bureaucratic little niche,” Brown said.

The bill was first introduced in Congress in 2011, but died in a House committee. The revived legislation has the support of the AARP, American Medical Association and even local hospitals.

“We support Sen. Brown’s efforts to look at this issue,” said Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association. “Our hospitals make a very conscious effort to let people know what their insurance covers and what their status is. But there’s lot of confusion with regard to the regulations, so any effort to look at this issue is a very positive step for everyone.”


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