Medicare Question

lking
on 8/9/15 6:12 am - Indianapolis, IN
RNY on 12/04/15

It's Sunday morning and I'm laying in bed while reading OH.  A thought just occurred to me with regards to the hospital stay when I have my RNY surgery.  

It's required that a patient be officially admitted into the hospital and remain hospitalized for 3 days for Medicare to cover any hospital stay.  Will this requirement be an issue for me?  

I don't meet with my surgeon until 8/25 to ask, so I'm asking here.  From my readings here it seems most people are in and out of the hospital in 1 or 2 days (most are 2).  Do the gastro surgeons keep the Medicare patients for 3 days so they get their Medicare coverage?

67 yrs old, 4'10", BMI 31.8 (51.8 at start), HW 256.4 (8/4/15), SW 217.4, CW 152.8 (4/30/18), GW 125.0, RNY 12/4/15 Dr. RoseMarie Jones, Breast Cancer DX 2/16, Bi-lateral mastectomy 8/9/16.

MsBatt
on 8/9/15 7:18 am

Since when do you have to stay three days??? I had a hernia repair where I only stayed one night---Medicare paid. I had a bowel obstruction, where I stayed two night---Medicare paid. Are you sure you mean MediCARE, not MediCAID?

lking
on 8/9/15 10:50 am - Indianapolis, IN
RNY on 12/04/15

MediCARE.gov is where I read it, I just read it again last week.  I will find it and post the link here.  Also, I read the info somewhere within this past year when I was getting ready to sign up for Medicare.

67 yrs old, 4'10", BMI 31.8 (51.8 at start), HW 256.4 (8/4/15), SW 217.4, CW 152.8 (4/30/18), GW 125.0, RNY 12/4/15 Dr. RoseMarie Jones, Breast Cancer DX 2/16, Bi-lateral mastectomy 8/9/16.

lking
on 8/9/15 11:10 am - Indianapolis, IN
RNY on 12/04/15

Here is some of what I read...read to the end.

https://www.medicare.gov/what-medicare-covers/part-a/inpatient-or-outpatient.html

67 yrs old, 4'10", BMI 31.8 (51.8 at start), HW 256.4 (8/4/15), SW 217.4, CW 152.8 (4/30/18), GW 125.0, RNY 12/4/15 Dr. RoseMarie Jones, Breast Cancer DX 2/16, Bi-lateral mastectomy 8/9/16.

mschwab
on 8/9/15 10:38 am
RNY on 11/21/14

Medicare coverage rules are complicated, but I'll try to explain. In order to be covered under the "inpatient" benefit, you must generally be in the hospital for 2 midnights.  Otherwise, your stay may be classified as an "outpatient" stay.  Many other medical issues come into play when determining hospital status for a patient, so it may not depend on LOS (length of stay) only.

The hospital status will not impact if your stay is covered, but may impact what you pay out of pocket, depending on your insurance coverage (traditional Medicare only, Medicare Advantage, supplemental coverage, etc.).  

Rest assured.  You're covered if you've been approved for surgery.

 

 Height: 5'7".  HW: 299, Program starting weight: 290, SW: 238, CW 138 - 12 pounds under goal!  

     

lking
on 8/9/15 10:53 am - Indianapolis, IN
RNY on 12/04/15

I have Plan F, so no out of pocket at all for me!

67 yrs old, 4'10", BMI 31.8 (51.8 at start), HW 256.4 (8/4/15), SW 217.4, CW 152.8 (4/30/18), GW 125.0, RNY 12/4/15 Dr. RoseMarie Jones, Breast Cancer DX 2/16, Bi-lateral mastectomy 8/9/16.

TanyaRN
on 8/10/15 3:41 pm - Palm Bay, FL

I am a nurse and the 3 night stay refers to having medicare cover rehab after hospital stay

MaronitaMay
on 8/11/15 12:51 am

I'm on Medicare and Medicaid in Massachusetts and had my surgery in 2012 and only stayed overnight and was paid.  I have heard that they are currently doing what you are talking about.  I would verify this with Medicare 1-800-MED-ICARE (1-800-633-42273) [yes, they do have an extra number than usual phone numbers] and if they verify that let the hospital know of this and get them to agree to keep you three days/nights.

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