Medicare billing, hospital medications put patients in sticky situation
So he was shocked last month when he received a
"It was really only about a day and a half of pills," Kohler, 78, said. "My God, $663!"
Kohler's experience illustrates a sticky situation for all parties involved: Hospitals don't want to be liable for potential drug interactions when patients are admitted, so they don't allow patients to bring their own meds from home. Patients don't want to pay for drugs they already possess. And insurance companies, who have already covered the patient's prescription once, don't want to pay for it again.
Washington Administrative Code (WAC 246-873-090, specifically) requires hospitals to develop their own policies and procedures "for the administration of drugs brought into the hospital by or for patients."
The code states that patients can only bring their own drugs from home when they have a written order from a practitioner, and if a hospital pharmacist examines them "to ensure acceptable quality for use in the hospital."
But those instances are rare.
"Logistically, and probably even legally, for the comfort of the pharmacist, they'd probably rather prescribe it (in the hospital) so they have more control and more knowledge of what the patient is actually taking," said
Kohler has had chronic obstructive pulmonary disease, or COPD, for about five years now, and ends up in the hospital for two or three days about twice a year. He carries with him a color-coded list of the 21 medications he takes for various ailments, 12 of which he needs daily.
Memorial's policy has always been the same: no meds allowed from home. But in the past, the drugs given at the hospital were covered by Kohler's insurance. He's never been billed before.
On
"It just kept getting worse, just started gasping toward the last," he remembers. His wife took him to Memorial's emergency room. "They thought I had pneumonia, so they said, 'We're going to keep you a few days.' My wife says, 'I'll run home and get his medication.' They said, 'No, we'll supply that; don't bring your medication.'
"We just thought it was all part of it," he said.
He was discharged on
But in June, the bill came. Under the line items showing
"I said, 'I didn't administer my pills; you guys did,' " Kohler said. "They said, 'Oh, we gave them to you, but you fed them yourself.' "
Hospital staff told him it was state law and that every hospital does the same thing, in an effort to avoid any harmful interaction between drugs.
"I said, 'Well, you could tell me if this pill's going to interfere or react with this one, and I won't take it, instead of charging me $663!' " he said.
From Memorial's standpoint, it's a safety issue. Drugs brought from outside generally lack barcodes, which conflicts with Memorial's normal process for medication use, says hospital pharmacy services director
"Our policy allows for patients to use their own medications if all requirements for safety and compliance are met, though it is rare that medications from home meet this criteria," Hull wrote in an email.
The hospital tries to keep costs low, Hull said, by only providing medications that "are necessary for a patient's acute needs during admission," and by the Meds-to-Beds program upon discharge, which has hospital pharmacists give patients the remainder of multidose medications that were started during their inpatient stay.
Because of the wording on the bill -- those "self-given" drugs --
And
However, she said, "This is really a safety issue, rather than a coverage issue ... It's the hospital's policy not to allow medication in, because they have no idea if what the patient is bringing in is what the bottle says."
"The only way for them to ensure is that they dispense it," Matson said.
The
In order for a patient to take from-home drugs in the hospital, a practitioner must submit an order to the hospital specifying the drug. When the patient brings it in, the hospital pharmacy must examine it and confirm that what's in the bottle is what the patient says it is. Then, when the patient is discharged, the hospital gives the remaining supply back.
Typically, providers only write those orders when the hospital does not stock the patient's particular medication, so most of the time, patients will take medications supplied by the hospital. And they should be part of the regular hospital-visit bill, covered to whatever degree insurance normally covers inpatient costs.
The
Similar complications can arise when patients stay overnight at a hospital but are kept in "observation status" rather than admitted in "inpatient" status -- a detail most patients aren't told about. The use of observation status came as a hospital reaction to
The distinction means the patient, not
Since the
Kohler said he tried to explain all this to the hospital to no avail. On top of that
"But
___
(c)2015 Yakima Herald-Republic (Yakima, Wash.)
Visit Yakima Herald-Republic (Yakima, Wash.) at www.yakima-herald.com
Distributed by Tribune Content Agency, LLC.
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News