discharge postponed due to weather...does insurance/Medicare pay?

[nervousnurse, ASN]

Curious...we had patients due to discharge on a day where we had a blizzard, so the d/c was postponed. Knowing how STRICT private insurance and Medicare are, I wondered...do they PAY for those extra days even though there was no medical reason for the patient to stay? (for the patients' sakes, I certainly HOPE so!!!)

[highlandlass1592, BSN, RN]

While I'm not a coder nor a discharge planner, I was told by someone in one of those departments that if it's not safe to discharge a patient home, then it is covered. Same issue when I lived in NC, when hurricane hit. If people couldn't be sent home safely, they stayed. Again, I have this information second hand so don't take it as gospel

[itsmejuli]

I think its more likely that the hospital will eat the cost of an extra night in the hospital rather than bill the patient.

Most hospital contracts are not per diem based whether through Medicare or private insurance.

I used to pay medical claims for a large private insurer. hated that job.

[handyrn]

Ok, the previous post made me laugh. I am sure that since the previous poster used to pay medical claims that he/she knows WAY more than me and may very well be correct in what he/she says, however, "I think its more likely that the hospital will eat the cost of an extra night in the hospital rather than bill the patient" made me laugh. I figured they would find a medical reason to keep the patient so that they can charge for it.

[nightengalegoddess]

Finding a medical reason would be the creative answer. It doesn't seem like that always happens although I love it. Usually takes a good nurse or case-worker to bring that up to the doctor. Good for the patient, good for the hospital. But normally I think the hospital eats it.

[nightengalegoddess]

Just wanted to add. Woudn't the patient's insurance be billed for the medical extra day? Not the patient directly usually.?

[itsmejuli]

Hospitals and other providers have contracts with insurers. Most often the contracts are DRG based and not per diem. For example: Jane Doe had a normal vag delivery...the insurance company's contract with the hospital is to pay $3400 for a normal vag delivery regardless of any extra nights unless there are complications. In this case the hospital's claim would have to be upcoded by case management in order for the hospital to get more money.

So if John Doe had a CABG done and he was ready to be discharged but a snow storm prevented him from getting home safely then the hospital cannot bill the patient for the extra night. Its not the patient's fault that he can't go home and there is no provision in hospital contracts to pay for "snow days". Under the terms of the hospital's contract with the insurer the hospital cannot bill the patient for something beyond the patient's control. Meaning that if the patient wanted to stay another night but was medically discharged then he would be billed by the hospital.

I really hated that insurance job....so glad I switched to nursing :)