Home Care near Del Mar Explains a Confusing Medicare Loophole

Millions of seniors across the country, including many under home care near Del Mar, depend on Medicare to pay hospital expenses. They assume that when they have a serious medical need, they will be able to get it addressed without worrying about bills piling up. But scrutiny of hospitals and doctors over possible Medicare fraud has led to a practice that leaves some seniors responsible for hospital bills—even though they are technically covered under Medicare.

Under Observation

In order to keep reimbursements under control, the Medicare program has to draw a line between services it pays for and those it does not. For hospital visits, that line is drawn at a short phrase—“under observation.” In other words, if a senior has a minor health threat and checks into a hospital in order to be supervised by doctors as a preventive measure, Medicare does not pay for the stay. Some hospitals, though, seem to have begun using the “under observation” category for patients with real health issues to avoid suspiciously high claims to Medicare.

Even More Reform Needed

A senior may not know that he was classified as “under observation” until the bills start coming in long after his hospital stay. Some facilities have even used the designation for patients with broken bones who needed a few days of rehab after they left the hospital. Appealing a hospital’s decision in this area brings yet more nightmares of red tape and prolonged delays, with no guarantee that the bills will eventually be reimbursed by Medicare.

Home Care in San Diego County Can Prevent Hospital Visits

A great way to avoid the issue of non-covered hospital visits is to have home care in San Diego County care for your senior loved one. With a caregiver in the house to perform tricky household tasks, slips and falls are far less likely. And an extra pair of eyes can spot early symptoms of illness before they progress to the point of requiring emergency room treatment.