Appealing Denial of Medicare Coverage

HNWElder Care Law, Elder Law

  • Your hospital admission status is a critical factor for Medicare coverage
  • Medicare says you must be admitted as “Inpatient” rather than as “observation status” for it to pay your bills
  • This article explains the differences between “In Patient” and “observation status” for Medicare coverage

You get sick.   You go to the hospital.   You are there for 3 to 4 days. You are discharged to home or to a rehabilitation center for rehab.  You have Medicare Part A and/or Part B.   You think Medicare will cover the bill.   You open up the bills  from the hospital, then the doctors, then the emergency room, then the pharmacies and you find out Medicare didn’t cover it all.  Stunned, you ask, “how can this be; I thought Medicare paid all/most of my medical bills”.   Guess what; in this case you were wrong.  Here’s why!

“Outpatient” vs. “Inpatient” Status under Medicare

One of the many things individuals over the age of 65 must contend with is hospitalization and whether they have been improperly classified for admission by a doctor.  It is important because even though a hospital visit may be covered under Medicare, how it is classified will determine any subsequent benefits the patient may receive, including, but not limited to, care received in a skilled nursing facility.  So if you get nothing out of my discussions here about Medicare coverage always remember to “Be Aware of Your Care!”  Your pocketbook, and your family, will thank you for it.

I will be writing an extensive article about Medicare coverage in my next post, so be sure to watch for it.

To discuss your NJ Medicare appeal matter, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at  Please ask us about our video conferencing consultations if you are unable to come to our office.

By Frederick P. Niemann, Esq., of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Denial of Medicare Coverage Appeal Attorney

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