Man Mistakenly Thought Medicare Would Cover Hospitalization

Ray Callahan is learning to take things a little easier, after surviving a health scare that landed him in the hospital for several days in July. The scare started with a pain in his chest.

"When I just took a breath, it would bother me," he said.

Ray thought he might be having a heart attack, so he ended up at Northwest Medical Center in Margate, where he says emergency room doctors were able to find the source of his pain after a series of tests.

"They took some pictures and came back and told me I had a large blood clot in my lung and I needed to stay in the hospital," he said.

Ray says he was taken to a different part of the hospital, where he stayed for three days.

"I said 'why can't I just go home and take these blood thinners?'" Ray said he asked the doctors. "They said 'no, we need to monitor you and make sure that the blood clot does not get loose and cause further damage.'"

Ray signed up for Medicare Part A earlier in the year. He thought the hospitalization would be covered by that plan so he had peace of mind. But when he realized the hospital was billing his stay to his employer-provided insurance and not Medicare, he called the hospital’s billing department.

"The lady on the phone said, 'oh, no, you were in for observation. Part A doesn’t cover that,'" Ray said he was told.

Ray says the information didn’t make sense.

"I was shocked," he said. "I'm in the hospital for three days, what do you mean I wasn’t admitted? That’s crazy."

Ray’s discharge papers included the following notice:  "Your physician placed you in the hospital as an outpatient and ordered observation services, but did not formally admit you as an inpatient. The reason for this notice is that Florida law requires that hospitals notify patients of their outpatient observation status upon discharge because your outpatient status may affect the amount you pay for your hospital services."

"I think it's very important that they're clear of my financial obligations based on how they’re putting me in the hospital," he said.  "I should know that right from the get-go."

NBC 6 Responds asked the hospital how a patient would know whether they’re being held for observation or admitted. The hospital released a statement saying they, "…cannot discuss individual patient cases…" and that "…all patients that present to our hospital are evaluated based on their medical condition, which will determine whether they need to be admitted or not."

A spokesperson for the Centers for Medicare and Medicaid Services, also known as CMS, could not speak specifically about Ray’s situation, but said Medicare Part A does not cover hospital observation services and that it is up to the hospital to determine how to classify a patient’s stay. Medicare also told NBC 6 Responds if a beneficiary was still working, "…then his employer insurance is primary over Medicare."

Ray says his health is improving but he is still worried about facing thousands of dollars in medical bills.

"That'd be pretty tough," he said.

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