MA Inpatient Hospital Stay

[usakr]

I called customer service and got two different answers. The plan says $300 for inpatient hospital stay. Does that cover all services the patient receives while in the hospital? Or does it cover only room charges?

 

[sman]

I called customer service and got two different answers. The plan says $300 for inpatient hospital stay. Does that cover all services the patient receives while in the hospital? Or does it cover only room charges?

All you need to do is look at the Evidence of Coverage (EOC) for that particular plan. I'm guessing it will have wording similar to this:

Includes inpatient acute, inpatient rehabilitation, long-term care hospitals and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day.

There is no limit to the number of days covered by our plan. Covered services include but are not limited to:
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Semi-private room (or a private room if medically necessary)
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Meals including special diets
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Regular nursing services
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Costs of special care units (such as intensive care or coronary care units)
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Drugs and medications
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Lab tests
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X-rays and other radiology services
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Necessary surgical and medical supplies
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Use of appliances, such as wheelchairs
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Operating and recovery room costs
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Physical, occupational, and speech language therapy
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Inpatient substance abuse services
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Under certain conditions, the following types of transplants are covered: corneal, kidney, kidney-pancreatic, heart, liver, lung, heart/lung, bone marrow, stem cell, and intestinal/multivisceral. If you need a transplant, we will arrange to have your case reviewed by a Medicare-approved transplant center that will decide whether you are a candidate for a transplant. Transplant providers may be local or outside of the service area. If our in-network transplant services are at a distant location, you may choose to go locally or distant as long as the local transplant providers are willing to accept the Original Medicare rate. If XXXXXXXX (plan name) provides transplant services at a distant location (outside of the service area) and you choose to obtain transplants at this distant location, we will arrange or pay for appropriate lodging and transportation costs for you and a companion.
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Blood - including storage and administration. All components of blood are covered beginning with the first pint used.
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Physician services

Note: To be an inpatient, your provider must write an order to admit you formally as an inpatient of the hospital. Even if you stay in the hospital overnight, you might still be considered an “outpatient.” If you are not sure if you are an inpatient or an outpatient, you should ask the hospital staff.
You can also find more information in a Medicare fact sheet called “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!” This fact sheet is available on the Web at http://www.medicare.gov/Pubs/pdf/11435.pdf or by calling 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. You can call these numbers for free, 24 hours a day, 7 days a week.

Prior authorization may be required and is the responsibility of your provider.

 

[traceyemoon]

I have seen an artificial knee billed as DME, so it would really depend on the service in some cased.