Medicare and the Two Most Financially Dangerous Words

A recent article by NBC talked about the two most damaging words that can go in your medical records when you go to the hospital (see the full article here:

Why, you might ask, does it make such a difference if you are “in observation” in the hospital or “admitted”?  Because of contracts….  Most people never read their Medicare contract.  But buried in the details of it, there is a statement that says Medicare will not pay for care unless it is medically necessary.  Further, a person must be ADMITTED to the hospital and HAVE A STAY OF 3 DAYS before Medicare will pay their share of the hospital stay and rehab time afterwards.

When hospital stays can range up to 5,000 per night, and rehab un its can be as high as 10,000 to 15,000 per month, knowing these two rules can be the difference in getting the insurance to pay or not getting the insurance to pay.

So, if you aren’t going to read the entire contract – and most of us never do! – you should at least know these danger words:

  • Be “admitted” to a hospital, not kept “in observation”
  • Argue and lobby to get the person to stay there for a minimum of 3 days (not 2.5 – this isn’t horseshoes or grenades, close will not suffice!).



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