Always Ask Before Being Admitted to a Hospital ~ Am I An Outpatient? Or Am I An Inpatient?

When being admitted to hospital, no matter the reason, you will be confronted with a bewildering array of paperwork. You may be unaware that 'admitted' includes two categories -- 'inpatient' and 'outpatient.' If you have Medicare Part A, Part B and Part D insurance policies YOU SHOULD ASK - "Am I an inpatient or outpatient?"

You do not have a choice, because Medicare sets the criteria. However, you should know because being an outpatient could be costly to you. Medicare rules define medications for which you have a prescription from your doctor as "Prescriptions (Self-Administered Drugs)." As an outpatient you are responsible for payment when a "self-administered" drug is given to you from the hospital pharmacy.

"Their cost can be extremely prohibitive, and in many cases Medicare members discover an outpatient is responsible for the hospital fees for those prescription drugs too late," Rod Haynes, Centers for Medicare Medicaid Services (CMS)/ Consortium for Medicare Health Plans Operations (CMHPO) Region 10, said.

This government publication explains how it works. 

You need to be very clear about which prescription drugs your Medicare-D insurer covers, and the conditions under which they pay, or in some instances, DO NOT PAY. This is vital knowledge before allowing the hospital to remove any self-administered drugs you've brought with you. Medicare rules stipulate,

"If you bring your prescription(s) from home, we [the hospital] are required to obtain approval from your physician prior to use. In addition, a hospital pharmacist must verify and certify the medication before it can be used in the hospital. There is a small fee for the medication verification."

There is no standing Medicare rule mandating that hospitals must allow patients to bring in their prescriptions when receiving care. Individual hospitals may or may not choose to permit this practice.

 

Why will prescription drugs you've brought (whether you're a patient in the ER or in a hospital bed) be sent home, leaving you to take medications from the hospital pharmacy instead? In most hospitals today there is no procedure whereby you can be charged a small fee and allowed to save substantial sums; the difference between what you will be charged for the hospital pharmacy's medications and your brought-from-home prescriptions. Even though they are identical.

Sean E. Dobbin, PharmD, Director of Pharmacy, Providence Sacred Heart Medical Center & Children's Hospital, explained that hospitals use digital-coding systems, much like the bar codes on items sold in stores. Hospital digital-codes coordinate your every medical procedure, including the medications you're given.

When a nurse scans the band attached to your wrist, it must match the digital-code on the medication being given. Although hospital administrators are concerned about the resulting high cost to patients, hospitals have not yet designed an efficient method to enter prescription drugs brought to the hospital by patients into their digital-coding system.
 

Complexities preventing this include: How can a hospital pharmacist ascertain the patient brought prescriptions that,

• Have been stored properly?
• Aren't from an expired batch?
• Are the strength the doctor prescribed?
• Or that dosage changes haven't been made since the prescription was written?

Hospital pharmacy fees for one dose can equal or exceed the price of a thirty-day supply of the identical medication sold at your pharmacy -- a substantial difference for which your Medicare-D insurer may not reimburse you.

Many diseases require medications that are catastrophically costly, yet vital to the patient. To miss even one dose may be highly risky or even deadly, but it's up to each hospital whether or not to accept the risk/liability of a patient bringing their prescriptions from home. Before relinquishing your medications, insist on meeting with the hospital pharmacist prior to taking any medication. This way, rules can be agreed on in advance regarding your self-administered drugs, or any drugs you know your Medicare-D has restrictions for.
 

The Medicare Rules also stipulate, "As a courtesy, we will bill your supplemental insurance on an "assignment" basis. This means we will ask the insurance company to pay us directly. Any amount not covered by your insurance will be your responsibility."
 

This does not apply to medications in the self-administered category. According to a finanial counselor at Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA, it means the hospital may bill for covered medications under Medicare Part A Supplement Plan. Hospitals do not bill insurance companies for self-administered prescription drugs received from the hospital pharmacy that are covered by Medicare-D insurance. The patient is billed and bears the responsibility to file a claim for reimbursement from their insurer.
 

Haynes said Part D is a separate matter entirely. "While hospital pharmacies are technically permitted to contract with Part D plan, it is very rare for them to do so because of financial constraints. If a hospital is willing to submit a patient's Outpatient drug claims to his or her Part D plan for reimbursement prior to billing the patient directly, such an arrangement would be entirely up to the hospital pharmacy. There is no Medicare rule mandating that the hospital do this," he said. The patient is left to suffer the consequences – or seek relief.

If for any reason you haven't reached an agreement with the hospital pharmacy beforehand, as soon as you receive their bill for the self-administered drugs you were given as an Outpatient, promptly talk to the hospital's Financial Counselor and to the Director of Pharmacy. Explain circumstances you feel should be considered, and request an adjustment. There are 'conditions' the hospital can apply to mitigate the charges.

If you need to file a claim for reimbursement from your Medicare D insurer, obtained the Prescription Drug Claim Form from the hospital's Outpatient Pharmacy Billing Department. The hospital pharmacist needs to fill out a form for each self-administered drug the hospital has billed for. Send your claim for reimbursement from your Medicare-D insurer before that insurer's deadline; keep copies.

If your claim is denied, attach copies from  your original claim and file an appeal. If a medication is not covered under your Medicare-D policy present the facts to the hospital's Director of Pharmacy and requested a review by that department. The charges may be mitigated and dismissed because of 'conditions' that meet certain criteria at that hospital.

If your insurance doesn't cover the costs, and you fail to get remediation from the hospital pharmacy, meet with the hospital's Financial Counselor. You may qualify for financial assistance, or at least be able to arrange an acceptable payment plan.

END

Sources:

Medicare.gov, the Official U.S. Government site for Medicare.

Search self administered drugs to get a the (pdf) Publication, "Self Administered Drugs" It explains how Medicare covers self-administered drugs given in hospital outpatient settings.
Here you can find 118 Publications that answer Medicare questions.
 

Give Yourself The Best Chance to Survive a Heart Attack or Stroke

Know how to give yourself the best chance to survive a heart attack or stroke. Learn to recognize symptoms, and take fast action!!

When the heart goes out of rhythm enough to cause a heart attack (your pulse feels irregular, too fast, too slow, or pounding) then it MUST be brought back into rhythm. You also need oxygen because your heart isn't pumping well enough to meet your body's need for blood-carrying-oxygen, especially to your brain. A doctor may prescribe medication, or you may need defibrillation.

You may not think clearly.

A quick assessment for stroke:
S -- Smile. If lopsided, call 9-1-1.
T -- Talk. Any difficulty with speech, call 9-1-1.
R -- Raise arms -- if unevenly raised,  9-1-1.

Call 9-1-1 immediately if you suspect a heart attack or stroke. It's better to be embarrassed than dead, or risk having your lifestyle diminished because you delayed.

If you are driving a car, the best thing to do is stop at the very first place where a phone can be found -- a house, a store, some motorist with a cell phone, wherever -- and call 9-1-1.

If you're 5 miles or LESS from the nearest hospital stopping by the roadside and flagging someone to drive you there could be a better option, because of the time it takes for an ambulance to reach you.

However, ambulances and fire department Quick Response units carry oxygen, which vastly improves your chances. So if you know an ambulance or fire station is close, that's your best choice.
END

Don't Risk Premature Hospital Discharge: Appeal

You've been in the hospital for three midnights, or more, as an Inpatient not an Outpatient, but you don't agree when your doctor says you're ready for discharge. It just doesn't 'feel right.' You're afraid. You don't want to land back in the hospital for the same ailment. You'd like a second opinion.

 

What can you do other than stay ~ and pay?

 

If you're an original Medicare beneficiary, appeal your discharge. Details and instructions are on the Important Message from Medicare (IM), given to you by the hospital when you arrived. You signed it, along with a batch of other admittance documents.

 

Lost the IM? Ask for a copy.*

 

If you suspect premature discharge, as soon as you learn of your impending discharge act quickly.

 

Protect yourself from a potential premature discharge by calling the Quality Improvement Organization (QIO) number on the IM.*

 

Called 'fast' or 'expedited' appeal, your phone call will start the process of a review made by a QIO. An 'expedited' appeal gets you a second opinion and buys time, without cost to you.

 

A QIO is under contract with the government: your medical records are examined by a physician, independent of the hospital, to review the medical necessity, appropriateness, and the quality of hospital treatment. The appeal is completed quickly and renders a final decision. The appeal also lets you stay in the hospital until noon (at least) of the day following your discharge date, and Medicare benefits apply during the time of the appeal process.***

 

You start the process by phoning QIO, and it should be completed in no longer than seventy-two hours, but you must call QIO before midnight on your discharge orders date.

• Upon receiving an appeal request from the beneficiary, the QIO must notify the hospital immediately of the review request.
• The hospital must provide patient records to the QIO by noon on the day after the QIO initially alerts the hospital to the expedited review request.

Note - there are reasons QIO may not alert the hospital for a considerable length of time, and also reasons why the hospital transmittal of records may not be complete for a considerable length of time - as long as seventy-two hour delays are possible.

 

Once the QIO notifies the hospital, the hospital is required to give a Detailed Notice of Discharge to the beneficiary (you) and to the QIO by noon the day after it is first notified of the appeal.

 

The Detailed Notice states the hospitals detailed rationale for the discharge. The QIO must receive a copy of the Detailed Notice in order to make a determination. The Detailed Notice also includes hospital contact information for the beneficiary.****

 

If you do not receive the Detailed Notice by noon the day after you contact the QIO with an appeal request, act quickly. Report this to the QIO so that the QIO can take action to facilitate delivery of the notice to you. You'll know your appeal is going as scheduled when you receive it.

 

The QIO must make its determination and notify the beneficiary, hospital, and physician within one calendar day of receipt of all pertinent information (delays can occur until records are complete.)

 

The hospital is prohibited from discharging you during your appeal, however if you leave the hospital before the review is complete, you abort your appeal.

 

If the QIO agrees that discharge is appropriate, you can agree to the discharge or you can file a reconsideration request for an independent review entity to review the case. If you stay in the hospital following receipt of a QIO decision that the doctor’s discharge orders are appropriate, you should receive a HINN12 from the hospital, because unlike the initial expedited review, there are no financial protections during the reconsideration process.

 

Sidebar:

• *Medicare, Medicare Advantage, and Medicaid each provide a hospital discharge appeals process.
• http://www.cms.hhs.gov/.
• ** If the beneficiary wishes to appoint a representative to file an appeal on his/her behalf, a valid Form 1696 or a conforming written instrument must be signed by both the beneficiary and the prospective representative and filed with the appeal request. In such cases the hospital has very specific obligations regarding notifications to the representative.)
• ***Medicare does not cover inpatient hospital services that are not medically necessary or could be safely furnished in another setting. (Refer to 42 Code of Federal Regulations, 411.15 (g) and (k)). Options also remain to appeal an adverse decision.
• ****Detailed Notice, Form CMS-10066, http://www.cms.hhs.gov/BNI/Downloads/Detailed_Notice_English_and_Spanish.zip.

END

 

Does your family know their ancestors? Perhaps it's time you shared with them what you know. And while you're at it, don't neglect finding ancestors and kinfolk on your family tree. None of us are getting younger, you know. ;0))

But how do I go about locating ancestors? you wonder.

Until Karen Drain read a newspaper account about her Honberger ancestors in Behind These Mountains , she said,

“I knew only that they were present for part of Heron’s history, for good or for bad! I found your books through genealogy research. My ancestor is listed in a newspaper clipping you included in a book.

 

When I found the listed page, I thought that the books would provide great reading material for my [91-year-old] Great Uncle Jack, who is helping me build the family tree. [And] my thoughts of buying your books in hardcopy were my only hope of sharing them with him."

She’d read the 1919 Sanders County Independent Ledger account of a “saloon keeper” whose business had been robbed. She contacted me. I connected her with people still living in the Heron area who might be helpful. Through them, she touched bases with others who also added to her knowledge about her family connection to former Heronites.

 

Karen said,

“Heidi [Dettwiler], Phoebe Harker, Linda Rocheleau, Fredi Pargeter, and Helen Meadows have all reached out to me and I am so humbled by everyone’s generosity in assisting me in my family search. You all are so wonderful!”

However, the Behind These Mountains trilogy she wanted to purchase has become rare out-of-print collectible books. Like most regional history books, they were limited editions; 1,000 volume 1 copies and only 500 copies of volumes 2 and 3.

 

Until I told her about requesting books through Inter-library loan, Karen wasn’t aware of that library service.  A librarian searches for them and when located, requests a copy that library clients can check out to read.

 

In 2009, Kindle editions of Behind These Mountains, Volumes I, II & III became available. Since there are about 1,000 vintage photographs from homesteader’s private albums in them I also offer .pdf formatted editions of the trilogy on a DVD for $50. The .pdf editions are a popular choice for those wanting print books because I include permission for a buyer to print [or have printed] a personal copy of each approximately 1200 page book. Karen elected to buy the DVD.

“I received my DVD today,” she wrote, “and I cannot wait to begin reading [on her computer’s large screen]! My hope is to print out a chapter at a time and send it to my great Uncle Jack. .. My thought is that he will have something to look forward to every week as I send him one or two chapters at a time.

I believe I mentioned that Jack is 91 and he doesn’t even have a working television, let alone a computer. His phone is not a fancy one either so hardcopy is the only way for him to read your book. I want to [print and] send a few chapters at a time so he has something to look forward to and he will check his mail more often than he does! Thank you so much for sharing all of your research!”

Her uncle plans to save the printed chapters and someday return them to Karen.

 

As she began reading the .pdf copies on her computer, Karen discovered Heron was beset in 1909 by smallpox brought in by a child who had returned from visiting relatives back east. Coincidentally, her relative, Flora Emma Honberger Dingley, died in Heron in January 1909. Now she wonders if smallpox caused Mrs. Dingley’s demise.

 

In a post on my Bygone Montanans blogspot, which is designed to help people with their genealogy research, I shared family information and photos of the Honberger and Dingley ancestors in Heron, that Karen had sent.

 

She responded, 

“Thank you for sharing my family history in your blog. Perhaps another family member will read it and add to the information. We are shaking the bushes, so to speak… We are very thankful to find you and your work.”

Laura Becquart, David Miller, Cindy Raynor, Tracey Lewis and Teresa Morkert are also among those who found the regional Montana history online.

 

When he got in touch, David said, 

"I found you at The River Journal and Montana Scribbler (contact)." 

Laura also emailed, 

“My name is Laura Becquart and I am interested in purchasing the pdf printable version of Behind These Mountains. I already have the book for volume 1 [original out-of-print edition], and it contains quite a few pictures. Do you know if the pdf version will contain pictures as well? Also, is the $50 for all three volumes?"

When I replied, she responded,

“Oh, this is too cool - I think I'm actually talking to Mona herself! You even signed my original edition of volume 1. My great uncle Lank (Loren Jameson) was able to get a signed copy for both my Mom and I. My Mom is Lucille Jenkins, the grand-daughter of Lucy Jenkins from Noxon.

My brother was trying to find volume 2 and 3 for my Mom for Mother's Day. I told him I would look around on the Internet and see if I could find anything for him. Of course, there wasn't anything out there, but I did stumble upon your Behind These Mountains website. 

Would it be acceptable for me to mail you a check? I'm fine waiting for you to cash the check before you would mail me the pdf file.”

We emailed back and forth as I related personal memories of times my husband and I enjoyed with her ancestors during the 60-years we lived near Noxon. Her check arrived and the DVD went in the mail the next day.

Tracey Lewis found ancestors in my books, connected with living kinfolk she learned about using Internet reseach, and traveled hundreds of miles to meet some of them in person. As the families connected, they used emails, phone calls and letters, to discover other members of the family tree, and organized a grand family reunion for fhose they found.

We learned much about our Gremaux family ancestors from a little-known out-of-print book in a library in Indiana. More information about that branch, and also the Vanek branch of our family tree, is located in a library in Lewistown, Montana. Many northwestern Montana settlers relocated to the lower Clark Fork River valley from the Plentywood area in Montana. The library there hosts detailed accounts of their lives.

 

How can you find your ancestors?

• Locate a library or museum in a town where an ancestor lived. Ask if any regional history books have been published. Request any that you find through Inter-library-loan. 
• Ask if there is a talking book or digital version. Many old books have been republished in a digital book, or online.
• Type family names into several online search engines. Each may return different results.
• Utilize Ancestry.com. You won’t need to subscribe to Ancestry.com if your local library has access that you can use free.
• Research ancestors through The Church of Latter Day Saints’ genealogy resources.

Unz.org is an excellent resource for locating books, periodicals and authors. The website has a powerful search engine, and is intended to provide convenient access to a large quantity of high-quality content material, mostly published over the last 150 years in America and England. It accesses over one million readable items, and titles of another million items not readable due to copyright.

You, too, might find and learn more about your ancestors in a little known regional history book. In doing so, you'll also make a author as happy as I am ~ knowing my work connects families.You may also have a grand reunion, like Tracey Lewis and her kinfolk, of family tree members you have yet to meet.

Facts About Cruise Ship Retirement

You've probably heard or read that spending your retirement years roaming the seas on cruise ships is the way to go and that it beats assisted living retirement communities in every way.

To learn the real facts, read "Is a Cruise Ship Retirement Cheaper than Assisted Living?" by Sarah J. Stevenson A Place For Mom.

Before you leave the website, follow the links to other important information. I highly recommend subscribing to the A Place For Mom blog.

How to Avoid Costly Mistakes

I'd like to direct you to A Place For Mom which has an excellent article today, How to Avoid Costly Mistakes in Your Search for Senior Living.

In the panel on the left here you'll find links the A Place For Mom home page and to other good resources to visit frequently.

When Wanting to Die ~ Burdens Shared Are Burdens Lightened

A few days after Christmas, we heard from a cousin that our 97-year-old uncle was critically ill and in a hospital. She said that after he was discharged he would likely need to be moved from Mariposa Gardens ALC into extended care. We took her assessment seriously. Less than six months earlier, uncle and aunty had moved into the ALC. This would present an even more difficult change for them.

My cousin added,

"Aunty is sweetly confused but is aware enough to realize life is taking a drastic change, and she is finding it difficult."

We'd emailed Christmas greetings to these Canadian relatives early in December, but hadn't worried when we didn't receive the annual holiday letter my uncle always wrote. Here, in Washington State, when Art and I moved into an assisted living community, I was beset with doubts and fears, especially during the first month. Long-standing rituals, like sending seasons greetings, diminished drastically.

A surprise email from my uncle arrived a few days after his niece's email. Although we still didn't know his current condition, we guessed his congestive heart failure had worsened.

 

We believed his every word when he wrote,

"My health took a downward turn, was in hospital 2 weeks and just home for a short duration. So thanks for all the visits and love, but this is likely the last you will hear from me. Uncle."

We emailed their only daughter to comfort her, and were pleasantly surprised when her reply said uncle was home with his wife at their apartment in the ALC and doing well.

Her email said both of her parents had their medications dished out by the facility, "instead of hit and miss as they may have been taking them. Dad wants to die. He doesn't want to live like this, but he's doing better than he thinks, and has a new walker to get to meals. Both are doing well for now, considering. However, Mom is starting to realize she may be alone soon. Despite her failing memory, she's struggling with that realization. We're thankful to the Lord for each day."

Uncle and aunty's reactions to their situation are somewhat like my own since Art and I moved to this ALC, and like that of other people I've known. Although my health has improved dramatically, on days when I feel ill and don't know the cause, I, too, wish to just die.

Despite the many wonderful aspects of being among our contemporaries the past four months, I understand that when an elderly ALC resident is hospitalized due to illness it's normal for them to become depressed and think the worst ~ that they may be dying soon.

And like Aunty, even though Art's health has stabilized these past months, I suffer panic attacks when I think beyond the now.

Here are four things that have helped me:

• I visit friends I've made, and we talk about our concerns, whether they are alone or have spouses or families who live nearby.
• I've formed bonds with several who have no family nearby to rely on for help and comfort in time of need. Sharing makes us each other's support system.
• We started a phone-calling tree ~ where each person calls the next on the list daily, rotating the list frequently. There is always someone at hand to share our cares.
• Talking to staff members also helps. Good ALCs have staff that truly have our wellbeing and happiness uppermost in mind and will guide us to someone we can rely on.

We take part in social activities, and encourage each other to attend. Support and encouragement also result from participating in exercises classes, religious services, and going on outings provided by the ALC.

 

Burdens shared are lightened in the caring.

END