Sara was experiencing extreme pain in her lower back and went to the emergency room. She resided in a Cleveland area hospital for five days and had back surgery to alleviate her condition. Unfortunately, she was never admitted to the hospital, even though she occupied a room for five days. Original Medicare states that a patient must be admitted for three days to be eligible for the skilled nursing benefit, otherwise known as rehab.
Since she had Medicare supplemental coverage, the required three day admission requirement was not met as she was categorized as “under observation” instead of admitted to the hospital.Her husband had to pay thousands of dollars for her rehab benefit which would have been covered if she had been admitted.
When you go to the hospital, specifically through the emergency room, ascertain if you are admitted to the hospital or merely under observation. Residing in a room is no guarantee of admittance. Know how your plan operates and what your coverage expenses are. If you have any questions about your health coverage, or are aging into medicare, and want to understand how the coverage works as well as what options you are entitled, I would be happy to offer my assistance, call 440-223-5437.