Straddling MAPDs- WHO PAYS?

[wehotex]

This is a first for me. I have a customer who was hospitalized on Dec 28, 2015 with Coventry insurance and discharged on Jan 8, 2016. Her Amerigroup insurance began Jan 1, 2016. Amerigroup says that Coventry will pay since they authorized it. I always thought that there was some kind of gentlemen's agreement that BOTH would pay. I haven't talked with Coventry yet.

 

[somarco]

In the hospital almost a year? What was the problem?

Generally, Coventry is responsible up to the discharge date. Amerigroup picks up following discharge.

 

[wehotex]

In the hospital almost a year? What was the problem?

Generally, Coventry is responsible up to the discharge date. Amerigroup picks up following discharge.

Thanks for catching that! Dec 28, not Jan 28. Thanks.

 

[somarco]

My response remains the same.

Unless something is different about MA (vs. group) hospital stays are treated as one claim, even when the hospital stay straddles two calendar years.

 

[bill3173]

changing plans while in the hospital seems kind of stupid.

 

[WCMason]

changing plans while in the hospital seems kind of stupid.

In this case the hospitalization began after AEP ended so the plan change was made before admission. Granted the enrollment could have been withdrawn between the 12/28 admit date and 12/31 deadline to withdraw. But if I made a decision to change to a better plan for next year I certainly would not want to go back to the plan I'm leaving for a full year because of hospital stay that carries over a few days into the new year.

 

[bill3173]

In this case the hospitalization began after AEP ended so the plan change was made before admission. Granted the enrollment could have been withdrawn between the 12/28 admit date and 12/31 deadline to withdraw. But if I made a decision to change to a better plan for next year I certainly would not want to go back to the plan I'm leaving for a full year because of hospital stay that carries over a few days into the new year.

Had a couple different MA cases this year with planned hospital stays that were interested in changing and I told them to stay put, to avoid this sort of thing.

Had one u65 with a planned hospital stay that overlapped the year end, and crazy bitch calls me while she's in the hospital, to check on the plan change, and that's when she let me know that she had the hospital stay planned for over a month. She insisted on changing plans, and then complained that she didn't have her new id cards and shitt.