|Susan Jaffe Kaiser Health News|
Sudden chest pains landed
"I just couldn't believe some of these prices they charge," said Zachor, 66. "It's just atrocious." For the price she was charged for her insulin during her 18-hour stay at
Even though her health plan covers medical and drug expenses, her policy would not pay the hospital drug bill because St. Luke's never formally admitted her, instead billing the visit as observation care, which is considered outpatient service.
That observation label excludes thousands of patients every year from full
These observation patients might wind up paying a larger share of their hospital bills than inpatients, since they usually have a co-payment for doctors' fees and each hospital service.
A shock, afterward
It's an unwelcome surprise for patients who may not get the bad news until they receive a hospital bill.
"St. Luke's carries out 'observation' and all other health care policies as prescribed by
Drug prices have also surprised seniors in other parts of the country:
– In Missouri, several
– In California, a hospital billed several patients
The most recent government statistics show the number of observation claims that hospitals submitted to
"I don't blame the hospitals," said attorney
The lawsuit seeks to either eliminate observation status or require hospitals to tell patients when they're admitted for observation and allow them to appeal the designation. Observation status "is a big money-saver for the
Difference in pricing
Since the program does not limit the prices for drugs that
Hospitals use their pharmacies to help generate revenue to subsidize the other operating costs of the facility, said
"I'm not justifying the charges," she said, "but there's a huge difference between the cost of operating a retail pharmacy compared to a hospital pharmacy."
Even patients with private
"These drugs may be covered under certain circumstances," according to the
Seniors advocate Dockins said that requiring hospital pharmacies to participate in the
To avoid drug charges, she tells seniors to bring their pills in the original bottles when they go into the hospital. But hospitals are not required to let patients use their own medicine from home, said
Dockins suggests that low-income seniors apply for a hospital's charity care program so that the charges can be waived or reduced, if they qualify.
Zachor, who works as an office manager for the
In February, her insurer said it requires hospitals with which it contracts "to notify a member before delivering a non-covered service." Because the hospital didn't obtain Zachor's written consent to accept those charges, the plan's rules say the hospital cannot bill her for them.
"What if I didn't know there was a route to go to appeal to my plan?" Zachor said. "I was thinking about other people older than myself who don't know what to do, and they would probably have to go without food or medications — for how long — to pay a bill they didn't have to pay."
|Copyright:||(c) 2012 (C) Gannett News Service|