inpatient care Archives

Can I Get Treatment for My Eating Disorder with Medicare?

Many people think eating disorders only affect young or even middle-aged adults, but not older adults. Unfortunately, this is not the case: eating disorders don’t simply go away with age. But it is only in more recent times that there has been recognition of eating disorders in older adults, and now the National Eating Disorders Association (NEDA) reports that 20% of women aged 70 and older are trying to change the size of their bodies.

Eating disorders can affect anyone at any age, but social stigma keeps some older women from seeking help. So if you or someone you know is dealing with an eating disorder, you are probably wondering if you can get treatment with Medicare.

Medicare Coverage

If you or a loved one are dealing with an eating disorder, you will be happy to know that many hospitals and treatment centers accept Medicare for the treatment of these conditions. But when it comes to paying for treatment, Medicare will first require you to seek outpatient treatment before they will pay for more advanced treatment options.

But regardless of the level of care required, Medicare will agree to pay for a reasonable and necessary treatment for beneficiaries’ eating disorders. Generally, Medicare will cover medication, therapy, and patient education.

Medicare will also usually cover a portion of inpatient care if your physician provides documentation that inpatient treatment is medically necessary for your situation. It is essential to note that Medicare does not cover outpatient treatment services for ongoing therapy after inpatient care. And similar to inpatient coverage, your doctor has to recommend outpatient care and psychotherapy.

Inpatient Care Vs. Partial Hospitalization

While, as noted above, you can get coverage for inpatient care for eating disorders with Medicare, they often prefer to cover partial hospitalization (PHP). PHP is covered by Medicare Part B and provides a structured program of outpatient services as an alternative to inpatient care.

Medicare will help cover these services when provided by a hospital outpatient department or Community Mental Health Center. It will also cover any occupational therapy that is part of your mental health treatment. And although Medicare covers the cost of treatment, you will still be responsible for a percentage of the payment for each Medicare-approved service that you receive. Typically Medicare will cover 80% of costs, leaving you to pay the remaining 20% out-of-pocket. There also be a coinsurance payment for each day of PHP services, regardless of the setting.

Extra Coverage

If you need help paying for the things that Medicare doesn’t cover, like out-of-pocket costs for treating an eating disorder, you can purchase a Medicare Supplement Plan. Your plan can help pay for the things that Medicare does not, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Federal Judge Rules Medicare Patients Can Challenge “Observation Care”

There may come a time in many seniors’ lives when they require emergency hospitalization. The hospital provides the necessary treatment, then they might send the patient to a nursing care facility for further care. If you find yourself in this situation, you might think that Medicare will fully cover both your hospital stay and your aftercare. But this is not always the case. If the hospital changed the status of your stay from “inpatient” to “observation care,” you would end up with a big bill, and you would have no way to appeal the decision – until now. At the end of March, a federal judge ruled that beneficiaries who were charged for aftercare after having their status changed can challenge the bills they received.

black and white pic of an elderly man sitting in a wheelchair — *Medicare has very specific rules about covering care in a skilled nursing facility.*

How Observation Status Affects Billing

Medicare has very specific rules about covering care in a skilled nursing facility. In order for your stay to be covered, you need to have been hospitalized as an inpatient for 3 or more consecutive days before going to the facility. But, if you are classified as “under observation” during your stay in the hospital, then you would be considered an outpatient, rather than an inpatient. This means that if the hospital labels your stay as “observation care,” any care you receive at a nursing facility would not be covered by Medicare.

If your status is changed from “inpatient” to “under observation” during your hospital stay, your aftercare could end up costing you thousands of dollars out-of-pocket – or you could even be denied care.

The Lawsuit & Its Ruling

In 2011, seven Medicare beneficiaries filed a class action lawsuit against the Department of Health and Human Services (HHS). In Alexander v. Azar, these beneficiaries argued that their status had been switched from “inpatient” to “under observation,” and that they should be given the right to appeal this decision.

On Tuesday, March 24, District Judge Michael Shea ruled in favor of all beneficiaries who had their statuses changed and then received large bills for aftercare. According to his ruling, any patient since January 1, 2009 who had been admitted as an inpatient by their doctor but later had their statuses switched are entitled to appeal the denial of their claims. The new ruling only applies to beneficiaries who were admitted as inpatients and then later switched to outpatient status by the hospital. If the doctor admitted them as “under observation,” then they cannot appeal.

Judge Shea estimates that hundreds of thousands of beneficiaries will be able to appeal and get reimbursed.

It can be frustrating to know the rules of Medicare, but not have any control over following them. Hospitals decide how to classify patients, and their decision could cost you thousands of dollars. Luckily, thanks to Judge Shea, Medicare beneficiaries now have a way to appeal these decisions, and possibly get out of medical debt.