CAPE GIRARDEAU, MO (KFVS) - It's just one little word, in or out?
In-patient and out-patient surgeries or procedures mean two very different things when it comes to your Medicare coverage and the difference can leave you with sticker shock.
"I've got a drug plan, I've got a supplement plan and I've got Medicare," Larry Drum of Cape Girardeau said.
Drum has been well prepared for the numerous heart surgeries and procedures he's needed over the years.
"So, with all the other procedures you've had to go through...." I started to ask.
"Everything was covered," Drum finished my thought. "I didn't cost me a dime."
"What did you think when you saw that?" I asked about the bill in front of him.
"I got mad," he answered with a laugh.
Drum shows me a $939 bill for three days worth of his daily medication, charged by a local hospital during the three days he stayed under observation after having his defibrillator removed.
"I thought I was being admitted," Drum said. "For an operation, that's usually what they do."
Here's why that distinction makes such a big difference.
In-patient procedures are covered under Medicare Part A, which pays for any medication given during your stay.
But, if it's an out-patient procedure or you're held for observation, Medicare Part B kicks in.
And it does not cover any self-administered medications.
"This is important because we don't want to end up with a bill if we can help it," Susan Cole said.
Susan Cole of Jackson is a nurse for a local surgeon. So, when her husband Bart went in for a heart procedure back in January, she knew what to ask.
"Is this going to be an in-patient or an out-patient procedure?" she recalled asking. "And no one seemed to know the answer or nor why it might be important."
Cole says she finally got her answer, when the bill came.
"A bill for $485for six pills that he has in bottles that he takes every day," she recalled.
Looking for answers, both the Drums and the Coles took their bills to Ruth Dockins with the Southeast Missouri Area Agency on Aging.
"Right now I think we have five that we're working on," Dockins said. "Hopefully, we'll get a partial reimbursement. It won't be as if they had purchased these drugs from an in-network pharmacy."
Dockins says seniors and their families need to ask whether a scheduled procedure will be considered in-patient or out-patient before arriving at the hospital.
She says many people think to ask their doctor, but he or she may not have the best answer.
"They need to ask a billing clerk or somebody like that at the hospital. An admitting nurse would know that."
For more information, you can contact the Southeast Missouri Area Agency on Aging at 1-800-392-8771.