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Discussion Starter #1
Have a relative, she's 80. Has lung problems, due to having TB when she was very young. About a month ago, she had to go to hosp for this. Got a letter from Medicare, saying they weren't going to pay anything. Said this hosp might be related to a fall she had 14 yrs ago. She's talked to Medicare several times. They told her problem had been fixed; not true. Her DD, is coming tomorrow; to try and help her figure this out. Question is, are they running some kind of program; on everyone's past Medicare history? Doesn't seem believable, they would just look at one persons past Medical history.
 

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Well, ya'll know there's been nearly 700 bill in medicare cuts w/new hosp rules. Which I thought meant you couldn't go back into a hosp w/same illness w/in a short period, for 1...but there prolly is a bunch more regs to hasten the demise of us oldies.
If she's contacted medicare w/o any help, I'd contact my congresscritter, for one...

Prayers & good thoughts.
 

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Are "we" talking to Medicare or an insurance company covering her healthcare expenses?
There is a difference on who to blame.
 

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My mil (who seems determined to bankrupt Medicare all by herself) and DH's 86 yr old uncle, who has metastatic melanoma and gets biweekly chemo and routine PET scans, haven't mentioned any Medicare changes. It may be just an error or she's misunderstanding something.
 

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She needs an ombudsman to help sort things out. First, medicare is NOT unlimited healthcare. That is plain from just reading the yearly book put out for it, and many people fail to recognize that. There is a lifetime max on some stuff, other stuff is limited to X # of times per year.

The response to billing is done through CMS. My first guess would be that the hospital was trying to tweak the diagnosis to get more money, second guess is that they did a coding error. Third guess is that someone at CMS is getting it wrong.

The battle is really between the hospital and CMS. If relative went in and was covered, the hospital has to abide by medicare rules.
 

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Got a letter from Medicare, saying they weren't going to pay anything. Said this hosp might be related to a fall she had 14 yrs ago.
Sounds like Medicare is claiming that it's a Hospital Acquired Condition (HAC), which Medicare has stepped-up efforts to enforce. It's aimed at things like acquiring an infection or sustaining an injury in the hospital. But while Medicare won't pay for HACs, it's also unlawful to bill the patient. The hospital is required to absorb the cost of treating those conditions.

http://www.cms.gov/Medicare/Medicar...italAcqCond/Hospital-Acquired_Conditions.html

So if the basis for denial is that it's a hospital acquired condition she isn't responsible for the bill.
 

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Discussion Starter #12
They told me their budget, had been cut so much, that their services were really limited. Thinking that's true, because don't think they would turn down money.
 
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