Insurance - HL 259 (3)

jt has left a new comment on your post "Insurance - HL 258 (1)":

If you are tricare for life..TFL..eligible, and served in Vietnam or other war zone, VA will provide top of the line hearing aids at no cost other than a $50 charge for office visits (2 visits...one for test / fittings and one to tweak the aids for your frequency requirements....mine retailed for over $6000....cost $100 for the office visits. Check it out!

J.T. Mullen

Editor: I can attest to the VA benefit for hearing aides as we applied and got the latest and greatest for my WWII vet dad.  As I recall there had to be a high noise environment creating damage while serving.  That's pretty easy since just  about every military job is exposed.  One tip though, on cleaning, adjusting and new batteries.  Don't go to vet hospital and wait hours on end to get this done.  Mail them in and they'll send them back all spiffed up.  It saves heartburn even though you may have to live without one for awhile.  I recommend sending in 1 at a time.

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From: Yorkieatl@aol.com

Date: 8/9/2016 7:48:28 PM

To: yorkieatl@aol.com

Subject: Fwd: New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage

 New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage

WASHINGTON — In November, after a bad fall, 85-year-old Elizabeth Cannon was taken to a hospital outside Philadelphia for six and a half days of “observation,” followed by nearly five months at a nearby nursing home for rehabilitation and skilled nursing care. The cost: more than $40,000.
The hospital insisted that Ms. Cannon had never been formally admitted there as an inpatient, so under federal rules, Medicare would not pay for her nursing home stay. The money would have to come from her pocket.
The experience of Ms. Cannon and thousands like her inspired a new Medicare law — in force as of Saturday — that requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted. Because of the Notice Act, passed by Congress last year with broad bipartisan support, patients can expect to start receiving the warnings in January.
“It was extremely distressful to my mother, who was frugal her whole life,” said Cynthia Morgan of Chadds Ford, Pa., Ms. Cannon’s daughter. “She asked, ‘How can I pay into Medicare for so many years, and now Medicare won’t help pay for my care?”’ Ms. Cannon died in April.
Hospitals have been keeping patients like Ms. Cannon in limbo — in “observation status” — for fear of being penalized by Medicare for inappropriate admissions. While under observation, patients can be liable for substantial hospital bills, and Medicare will not pay for subsequent nursing home care unless a person has spent three consecutive days in the hospital as an inpatient.
Time spent under observation does not count toward the three days, even though the patient may spend five or six nights in a hospital bed and receive extensive hospital services, including tests, treatment and medications ordered by a doctor.
Under the new law, the notice must be provided to “each individual who receives observation services as an outpatient” at a hospital for more than 24 hours. Medicare officials estimate that hospitals will have to issue 1.4 million notices a year.
“The financial consequences of observation stays can be devastating for seniors,” said Senator Susan Collins, Republican of Maine and the chairwoman of the Senate Special Committee on Aging.
Senator Benjamin L. Cardin, Democrat of Maryland, the chief sponsor of the Senate version of the legislation, said it would “save seniors from the sticker shock that comes after they are discharged from the hospital and realize that Medicare will not cover the cost of care in a skilled nursing facility.”
The median cost for a private room in a nursing home is roughly $92,000 a year, according to a survey by Genworth Financial, an insurance company. Medicare covers up to 100 days of skilled nursing home care at a time.
The text of the standard “Medicare outpatient observation notice” is subject to approval by the White House Office of Management and Budget. In its current form, the notice to beneficiaries says: “You’re a hospital outpatient receiving observation services. You are not an inpatient.” And it explains that Medicare will cover care in a skilled nursing home only if the beneficiary has had an inpatient hospital stay of at least three days.
Patients can then consult their doctors and may ask to be reclassified as inpatients.
Hospitals have found themselves in a squeeze. They increased their use of “observation status” in response to close scrutiny of their billing practices by Medicare auditors — private companies hired by the government to review claims. In many cases, these companies challenged decisions by doctors to admit patients to a hospital, saying the services should have been provided on an outpatient basis. The auditors then tried to recover what they described as improper payments.
Doctors and hospitals said the auditors were like bounty hunters because they were allowed to keep a percentage of the funds they recovered.
But patients now will at least be better informed. The Senate Finance Committee explained the reason for the law this way:
“The number of Medicare beneficiaries receiving outpatient observation care over the last several years has been steadily increasing. Some beneficiaries are surprised to learn that although having received treatment overnight in a hospital bed, the beneficiary was never formally admitted as an inpatient but was instead a hospital outpatient.”
Federal officials acknowledged that Medicare beneficiaries sometimes had to pay more as outpatients under observation than they would have paid if they had been formally admitted to the hospital and received the same services as inpatients.
The administration issued rules last week to carry out the new law. The purpose, it said, is “to inform beneficiaries of costs they might not otherwise be aware of.”
“Even if you stay in a hospital overnight, you might still be considered an outpatient,” the administration said in a publication for beneficiaries.
Consumer advocates and nursing homes support the new requirement.
“Medicare beneficiaries are spending more and more time in the hospital without being formally admitted,” said Joyce A. Rogers, a senior vice president of AARP, the lobby for older Americans, adding that this “can expose beneficiaries to unexpectedly high out-of-pocket costs amounting to thousands of dollars.”
Mark Parkinson, the president and chief executive of the American Health Care Association, a trade group for nursing homes, said, “Patients often have no idea what their status is in a hospital.” Observation stays impose a “financial burden on seniors,” he said, and increase the likelihood that they will have to turn to programs like Medicaid, the federal-state program for low-income people.
“The new law is an important first step, but Congress and the administration need to do more to protect beneficiaries,” said Judith A. Stein, the executive director of the nonprofit Center for Medicare Advocacy.
Under the law, hospitals can still keep Medicare patients in observation status, and some of the patients will be responsible for nursing home costs. Twenty-four senators and more than 120 House members are supporting bipartisan legislation to address that concern. Under that bill, time in a hospital under observation would count toward the three-day inpatient stay required for Medicare coverage of nursing home care.

http://www.nytimes.com/2016/08/07/us/politics/new-medicare-law-to-notify-patients-of-loophole-in-nursing-home-coverage.html?emc=edit_tnt_20160806&nlid=46554331&tntemail0=y&_r=0

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From: Yorkieatl@aol.com

Date: 8/9/2016 7:24:09 PM

To: yorkieatl@aol.com

Subject:  Not so affordable care act

Hospital Stay - Important please read. 

ALL SENIORS BETTER READ THIS!!!  from a senior gentleman in Mesa, Arizona:  

Family, Friends, Neighbors, and former Classmates,      

I just found myself in the middle of a medical situation that made it very clear that "the Affordable Care Act" is  neither affordable, nor do they care.   

I'll go back about seven years ago to a fairly radical prostate surgery that I underwent. The Urologist who performed the surgery was very concerned that it was cancer, though I wasn't told this until the lab report revealed it was benign. Since that procedure, I have experienced numerous urinary tract infections, UTI's.   Since I had never had a "UTI" prior to the prostate surgery, I assumed that it is one of the side effects from surgery, an assumption since confirmed by my Family Doctor.      

The weekend of March 8-9, I was experiencing all the symptoms of another UTI.   By Monday afternoon the infection had hit with full force.  Knowing that all I needed was an antibiotic, I went to an Urgent Care Center in Mesa, AZ, to provide a specimen a requirement for getting the prescription.  After waiting 45 minutes to see the Doc tor, I started getting very nauseous and light headed.   I went to the Receptionist to ask where the bathroom was, as I felt that I was going to throw up.   I was told that I would have to wait for the Doctor because I would have to leave a specimen and they didn't want me in the bathroom without first seeing him.   That was when the lights went out. My next awareness was that of finding myself on the floor (in the waiting room) having violent dry heaves, and very confused.  At this point, I tried to stand up but couldn't make it, and they made it very clear they weren't going to let me get up until the ambulance got there.  By the way, when you're waiting to see the Doctor and you pass out, you get very prompt attention. 

Now, "the rest of the story", and the reason for sending this to so many of you.      

I was taken to the nearest hospital, to emergency. Once there, I was transported to an emergency examination room.   Once I had removed my clothes and donned one of those lovely hospital gowns, I finally got to see a Doctor.  I asked "what is going o n?  I'm just having a UTI. Just get me the proper medication and let me go home." He told me that my symptoms presented the possibility of sepsis, a potentially deadly migration of toxins, and that they needed to run several tests to determine how far the infection had migrated.      

For the next 3 hours I was subjected to several tests, blood draws, EKG's, and demands for specimens.  At about 7:30 the nurse came back to my room to inform me that one of the tests takes 1- 2 days to complete.   

I asked if they (the results) could be emailed, at which point she informed me that I wouldn't need them emailed because I wasn't going anywhere. I did tell her I wanted to see the doctor because I had no intention of staying overnight.      

Now, this is what I want each of you to understand. Please read these next sentences carefully.      

The doctor finally came in to inform me that he was going to admit me.  I said, "Are you admitting me for treatment or for observation?"  He told me that I would be admitted for observation.  I said, "Doctor, correct me if I'm wrong, but if you admit me for observation, my Medicare will not pay anything, this due to the Affordable Care Act."   He said, "That's right, it won't."   I grabbed my bag of clothing and said, "Then I'm going home."   He said you're really too sick to be going home, but I understand your position. This health program is going to hit seniors especially hard. 

 The doctor then left the room and I started getting dressed.  I was just getting ready to put my shoes on when another doctor (the closer) came into the room. He saw me dressed and said, "Where do you think you are going?" I simply said "I'm going home."  To which he replied, quite vociferously, "No you aren't."  I said, "Doc, you and I both know that under the "Affordable Care Act" anyone on Medicare who is admitted to a hospital for observation will be responsible for the bill. Medicare won't pay a cent."  At which point he nodded in affirmation.  I said, "You will either admit me for a specific treatment or you won' t admit me." Realizing he wasn't going to win this one, he said he would prepare my release papers. 

A few minutes later, the discharge nurse came to my room to have me sign the necessary papers, relieving them from any responsibility.  I told her I wasn't trying to be obstinate, but I wasn't going to be burdened with the full (financial) responsibility for my hospital stay.   After making sure the door was closed, she said, "I don't blame you at all. I would do the same thing."  She went on to say, "You wouldn't believe the people who elect to leave for the same reasons, people who are deathly sick, people who have to be wheeled out on a gurney."

She further said, "The 'Affordable Care Act' is going to be a disaster for seniors. Yet, if you are in this country illegally, and have no coverage, you will be covered in full."   This is not Internet hype folks, this is real. I just experienced it personally.    

Moving right along, this gets worse.   

Today I went to a (required) follow up appointment with my Arizona Family Practitioner.  Since my white count was pretty high, the follow up was important.   During the visit, I shared the experience at emergency, and that I had refused to be admitted. His response was "I don't blame you at all, I would have done the same thing."  

He went on to say that the colonoscopy and other procedures are probably going to be dropped from coverage for those over 70."   I told him that I had heard that the "Affordable Care Act" would no longer pay for cancer treatment for those 76 and older, is that true?  His understanding is that it is true.   The more I hear, and experience the Affordable Care Act, the more I'm beginning to see that we seniors are nothing more than an inconvenience, and the sooner they can get rid of us the better off they'll be.      

We can have an impact on this debacle by letting everyone in Congress know that their responsibility is to the constituents, not the president and not the lobbyists.   We need to let them ALL know that they are in office to serve and to look after the BEST INTERESTS of "we the people," their employers, and not to become self serving bureaucrats who serve only out of greed.   And if they don't seem to understand this simple logic, we'll fire them.      

REMEMBER:      

Demand your hospital admission is for TREATMENT and NOT for OBSERVATION!  Don't believe this? Ask your doctor. 

SEND THIS TO EVERY SENIOR AND ALL MILITARY (ACTIVE OR VET) AND LET THEM KNOW THIS IS HOW OUR REPRESENTATIVES ON CAPITOL HILL TREAT THOSE WHO RISK IT ALL SO THEY CAN SIT UP THERE AND ENJOY ALL THE BENEFITS THEY EXEMPT FROM THE REST OF US. 

 


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