Coverage:
The patient is under 65 and considered disabled by the Social Security Administration, therefore entitled to Medicare Part A Insurance. The patient is also a Military Veteran, with access to Veterans’ Administration Healthcare.
Condition:
The patients condition requires regular doctor care and possible hospital services on an unpredictable and possibly frequent basis.
Situation:
The patient was billed for the Doctor’s Services during an Inpatient Hospital Visit. The information from Medicare looked like a bill for the inpatient stay.
Medicare Part A: States In-Patient Hospital Services are covered and that the patient must sign a Notice that the services may result in a Hospital Bill, providing the patient an opportunity to decline services.
Issues:
The patient was not formally briefed on Medical Benefits when automatically enrolled in Medicare. The patient was also informed she could use the Veterans’ Choice Program to cover hospital services when in need. The patient was not briefed on the details of either program; the patient assumed she was covered since she was considered disabled and covered under Medicare Part A.
The patient received a bill and was told by Medicare that the bill is for Doctor Services. The patient doesn’t understand how or why they state the patient is covered with Medicare Insurance, but Doctor’s Services are separate. The patient feels either an Inpatient Hospitalization is either covered or it isn’t; since her past hospitalizations were covered and there is no purpose of an In-Patient Hospitalization if the patient doesn’t receive services from a Doctor. The patient was not informed she may incur additional costs and was not offered an opportunity to decline services.
Problem:
The problem resides with the ambiguity in the Healthcare System as a whole. The information is unclear and the patient was never provided an opportunity to decline services or discuss her benefits to pursue other treatment options. The system does not address the ongoing need for Medical Services and the likelihood of use or the feasibility of payment for financially and mentally disabled patients.
Solution:
The patient can appeal the bill, but under what basis?
The major problem with healthcare services, especially with the disabled population is the ambiguity in plan coverage as well as the feasibility of payment for services. If a person is disabled, their income decreases dramatically, often-times below the poverty line, making it difficult to pay for medical expenses. If this patient is required to pay for hospital services at the cost of $790 per visit and has a condition that will most likely involve regular hospital visits, then the odds of this patient paying for such services is slim to none, forcing the disabled patient to not only live with a Medical Condition, but also to live below the poverty line and potentially with bad credit.
The patient makes too much money on Social Security to qualify for State Funded Medical Programs, forcing her to pay for services or other Medicare Coverages that are ambiguous and costly.
The patient has bills to pay to support herself, which include rent, utilities, food and other possible expenses to survive. Without basic coverage and even with an affordable premium, the patient becomes financially disabled, unable to change her lifestyle and pay for much needed services. The patient can’t even afford to pay for Dental Services. This contributes to the patients Mental Condition of Depression and Anxiety since she was once able to pay for basic services and live a comfortable lifestyle.
If she arranges a payment plan for past hospital services and visited the hospital twice in one year, the patient is charged over $1400 for that year, not counting the cost of the patients’ prescription drugs or outpatient treatment. The disabled (mentally disabled) patient may be coerced into paying a monthly payment for the hospital bills, when this was part of her Part A or Part B coverage.
Unfortunately, the Medicare Department does not adequately offer advice for best coverage options for specific scenarios, leaving the mentally disabled patient to make her own decisions that may not be in her best interest medically or financially.
This ensures a cycle of sickness for patients with Mental Disorders suffering from Anxiety, Depression and other Mood disorders. It’s no wonder the Depression cannot be cured. The patient was also a Veteran of the US Military and further questions the reasons she fought for her Country as it doesn’t appear to be a Country that can realistically take care of an Aging and Disabled population, even if they did once earn $90,000 per year.