On the morning of Sept. 23, 2014, Caroline Giada woke up in her home in coastal New Jersey. She rose from bed, walked over to the bathroom and fainted, hitting her back on the sink cabinet on the way down. When she came to, she couldn’t move. So she called 911.
The 76-year-old was taken to the emergency room, where the attending nurses looked her over and booked her into a bed. Over the next six days, she was given every kind of test imaginable: X-rays, electrocardiogram, CT scan, ultrasound, MRI. Nurses came and went. So did doctors. Finally, a week later, the problem was uncovered: a fracture in the L5 segment of Giada’s lower spine. They called in a specialist, but he said he couldn’t operate until the following Thursday.
Then the hospital kicked her out.
“They told me they couldn’t keep me, because they couldn’t do anything else for me,” says Giada. (At her request, her name has been changed to maintain her privacy.) Her choices were to go home or to a costly private nursing facility nearby. She chose the latter, thinking that given her intense pain and lack of mobility, she’d need the care the nurses could provide. And even though the facility demanded payment upfront, Medicare would reimburse her, she thought. It was a decision she would come to regret. “When you are in a lot of pain, you really don’t think too clearly,” she says.
After her surgery and rehab, when she was ready to go home, Giada was hit with another surprise: a bill. Medicare had covered the surgery and the rehab, but not the nursing facility stay, and the facility told her she owed $2,360. “I couldn’t understand it,” says Giada. “They said, ‘Well, Medicare isn’t paying, because the hospital put you under observation instead of as an inpatient.’” That was the first she’d heard of it.
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