Tuesday, November 22, 2011

Why is medical care so costly?

But wait! The story of my incapacitated 85-year-old mother's bureaucratic woes has not ended. This next battle is with Medicare and her BC/BS supplemental insurance providers.

Last February, my mother was transported to the ER after collapsing at her Assisted Living home. There, they kept her overnight to evaluate the possibility of a seizure and released her in the morning. During her hospital stay, they administered her regular regimen of medications.

In July, Medicare sent a notice that they had re-reviewed her claim. After months of calls and sleuthing and some truly incompetent clerks passing me along, I finally talked to a person who was able to explain what happened: Medicare retrospectively changed their coverage, and we were being charged $460 for one day's worth of her medications because my mother was not admitted to the hospital but was kept as an "outpatient" overnight.

My mother has Medicare Part D (Drug) coverage, so I called BC/BS to find out why they weren't paying for the same drugs they normally cover. Well, the nice lady there explained that Part D coverage only covers scrips from the doctor that are filled at a pharmacy and "self-administered." I explained that my mom is in Assisted Living because she can't remember to take her meds and the nurses at the facility always administer her drugs. This proxy assistance apparently does not negate the "self" part of the administration at Assisted Living, but hospital-provided and administered drugs are definitely not eligible for Part D coverage.

Thinking Mom's regular supplemental coverage for hospitalization might cover them, I checked that, too. According to the hospital, they've been billed and also denied the coverage – presumably because the drugs were not part of the hospitalization care or maybe because Medicare originally covered them. Who knows for sure? Not the hospital.

At any rate, because her Assisted Living drugs weren't sent along to the ER, we're supposed to pay MORE for ONE day's dosage($460) than her month's supply of the medications normally cost (about $350)? I don't think that is either fair or equitable for the hospital to expect – from us or from any of the coverages either for that matter.

If these are typical charges hospitals have been passing on to Medicare and insurers, it is no wonder healthcare costs are breaking the budget.
I wonder... what you think.

1 comment:

Jerry said...

Interesting...When I had cardiac surgery in May2011, I was told to bring my meds in their original containers. I assumed that was so that I could take my own prescribed medications. The real reason as I was later informed was to assure that the hospital could confirm my correct meds and doses. As I had brought my own prescriptions, I took them from my own supply as required during my stay. The invoicing for my procedure included "self administered drugs" which were not covered by Medicare and therefore, not covered by my supplementary insurance. I'm in the process of fighting this claim.

I was admitted to the hospital again in Nov. During my stay, I was subjected to numerous instances where the staff tried to administer drugs which were on my list of prescribed meds. I refused to take any of them, (based on my previous bad experiences regarding billing) and took the prescriptions from my own supply. We'll see when the bills come in what, if any, effect my refusal to take the "self administered drugs" will have.