Hospital Status Can Affect Your Co-Pay Significantly

When you’re sick or injured, the last thing you need to worry about is whether your insurance will cover your hospital stay and any rehabilitation treatment you may require.

Knowing how Medicare and its gap providers figure the ways in which they will (or won’t) pay on your claim can save you – or the person serving as your proxy/health care agent – money, time, and stress.

Medicare rules require patients to be admitted to a hospital for three days before coverage begins. A patient who then receives treatment in a skilled nursing facility will have their rehabilitation covered by Medicare Part A (Hospital Insurance) and any “medigap” insurance, per policy guidelines.

Patient advocates advise that you review your policy before you need it, and offer these tips to ensure your bill is managed properly:

  • Ask your physician if (s)he accepts assignment, which means they have agreed to be paid directly by Medicare, to accept the amount which Medicare approves, and to not bill you – the patient – for more than the Medicare deductible and coinsurance.
  • Ask your doctor or the hospital about your status. Traditionally, observation applies to a stay of 24 hours or less. If your stay is more than 24 hours, ask your provider to formally admit you.
  • Let your doctor know how observation status can affect you financially.
  • If you are referred to a skilled nursing facility (SNF) for rehabilitation, ask your physician or the hospital to ensure you have met the three-day requirement for admittance, in order that your SNF stay is covered by Medicare and your Medicare supplement insurance.
  • If you are discharged but require additional rehabilitation, ask your doctor if your rehabilitation can take place with a visiting therapist at home. (Make sure you have Medicare Home Health benefits, and that pre-treatment requirements are met).


At Windsong, we design homes and communities that encourage active adults to stay healthy and active. Just as you researched the location and design elements of your home, we encourage you to familiarize yourself with your health care insurance, for your peace of mind, as well as to ensure you return to good health and activity quickly.

Welcome home to Windsong – Where Life’s A Breeze!

, , , , , , , , , ,

No comments yet.

Leave a Reply