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Medicare A experts

Discussion in 'The Okie Corral' started by dherloc, Mar 27, 2012.

  1. dherloc

    dherloc X-Nuc

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    If you can be one of those...

    Mom (age 66) just had rotator cuff surgery. Turns out since she did not stay overnight in the hospital, Medicare will not pay for it and she was under the impression that they would. Her insurance picked up 38 thousand of the surgery, but now she is on the hook for 22 thousand.

    Is there an appeals process? What is her chance of getting the appeal?

    What is her option if the appeal is not approved?

    Thanks for the help.
     
  2. Dinky

    Dinky Numpty

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  3. Dennis in MA

    Dennis in MA Get off my lawn

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    She doesn't have a major medical add-on????
     
  4. Buki192327

    Buki192327

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    Medicare only pays 80% of the approved amount. This is why you want to get a medicare supplement policy. It will pickup what Medicare doesn't cover.
     
    Last edited: Mar 27, 2012
  5. dherloc

    dherloc X-Nuc

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    Think the problem is that the HR rep told her between her insurance (state employee) and medicare that she would be covered and didn't need the suplement.

    The problem is that medicare completely denied the claim. From what she understood talking to them, it was covered until they decided to release her without an admission to the hospital. The guy they operated on after her (she was discharged at 9pm) got an overnight stay and would have been covered.

    Just trying to figure all this out and what her options are. Never had to deal with this stuff in the past.
     
  6. dherloc

    dherloc X-Nuc

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  7. MB-G26

    MB-G26 Queen of Fail Lifetime Member

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    I some states, there ARE NO "medical/supplement
    type back up type available.

    It sucks to need Medicare; it sucks when every single, individual person who honestly needs a series of meds NONE OF WHICH ARE ON THEIR STUPID (#&$%%^@&*#$oik$ FORMULATORY."