Bellevue family stresses with Medicare issues over observation

BELLEVUE, Neb. (WOWT) - A Bellevue family has been under a lot of stress both emotionally and financially. What will shock you is that it’s all caused by one word.

A concerned son is caring.

“That hurt when you bend your fingers out?” said son Vince Bruce.

Vince Bruce says his 81-year-old mother needs skilled care and Hillcrest staff told him the cost wouldn’t be completely covered because of how a hospital stay has been worded.

“And we didn’t realize it until they told us under observation the whole time, she was in the hospital not admitted that way your insurance won’t cover it. The insurance will cover the nursing part but the room and board has to be covered by you,” said Vince.

Before approving complete coverage in a skilled nursing facility, Medicare requires that a patient must first be admitted for three overnights in a hospital. After a fall then stroke, Patricia Bruce spent five nights at Nebraska Medicine Bellevue.

But her family says they learned she had not been admitted, putting complete Medicare coverage in jeopardy.

“Who knows to go to the hospital and ask are they admitted or are they observed just to make sure your insurance will pay. Nobody knows that,” said daughter-in-law Doreen Bruce.

The couple asks why hospital paperwork showing an admit date isn’t an admission of being admitted.

The couple has filed an appeal with Nebraska Medicine asking the record to be changed to show when the 81-year-old spent here she was not being observed but admitted. Vince says full Medicare coverage for his mom’s skilled nursing costs would relieve family stress.

“Every day we think about where we are going to come up with next month’s money if we need to come up with next month’s money just because the words say they had her under observation and not under admitted,” said Vince.

The staff at Hillcrest made a skilled financial move on Patricia’s Medicare coverage.

“We were able to find a way for the family not to have to pay for rehabilitation care by taking advantage of the three-day waiver that’s in place during the pandemic. Normally you need a three-day hospital stay to have Medicare cover rehab stay and in this case because of the waiver that patient is able to go on service and have that care covered right away,” said Jim Janicki, Hillcrest Health Services.

So, without putting a financial strain on the family, Patricia will stay in the Hillcrest skilled nursing facility.

“A facility that can help take care of her and she can have her comforts with her, which would be Big Papi,” said Doreen.

The lifelong Redsox fans are thankful for those who went to bat for Patricia’s full skilled care coverage.

Nebraska Medicine can’t comment on specific patient records. But a statement says, “every patient admitted to a Nebraska Medicine facility is assessed for their medical needs and given the appropriate patient status as either inpatient or observation. That status is reviewed throughout the stay and follows the centers for Medicare guidelines.”

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