NeuroPsychiatric Hospital Care May Be Impossible for Seniors on Medicare Advantage Plans

Dr. Cameron Gilbert founded NeuroPsychiatric Hospitals, a chain of behavioral health specialty clinics serving patients in Arizona, Indiana, and Texas, to meet the unique needs of seniors suffering both frailty and psychiatric illness requiring hospitalization.

Who are the patients NeuroPsychiatric Hospital serves? Dr. Cameron Gilbert offers some examples:

• A 67-year-old displaying symptoms of dementia just two weeks after open-heart surgery.
• An 85-year-old diabetic on dialysis who becomes violent and delusional.
• A 22-year-old in custodial care on the autistic spectrum who is in a car accident with broken bones, deep wounds, and an infection.
• Patients of any age who are working through both substance abuse and a serious medical condition.

Meeting the needs of patients who have psychiatric and physical challenges was the reason for founding NeuroPsychiatric Hospitals. Dr. Gilbert saw the need to address the care of people who are too psychiatrically impaired to be admitted to a general hospital and too physically impaired to be admitted to a psychiatric hospital.

Many of the patients NeuroPsychiatric Hospital serves, Dr. Gilbert points out, seek care in emergency rooms because they can’t get care in a hospital. This places a significant burden on the ER, which typically isn’t prepared for patients who suffer suicidal intentions, poorly controlled violent impulses, or the inability to communicate their symptoms accurately and truthfully. Even for patients of all ages on Medicare, there are limits on reimbursement for care in the ER unless the patient is admitted to a hospital. The patient and the family are hit with catastrophic bills for ineffective treatment.

Even when a NeuroPsychiatric Hospital is available for the treatment the patient needs, the wrong Medicare plan can be its own catastrophic decision.

It’s difficult to watch television for very long without seeing former New York Jets and LA Rams quarterback Joe Namath hawking Medicare Advantage plans. These plans seem to have several attractive features, chief among them cost.

Medicare Advantage plans often offer benefits for prescription drugs, so the covered person doesn’t have to enroll in Plan D. They may, as the ad points out, cover dental procedures, dentures, hearing aids, glasses, trips to the doctor, and even hot meals for home delivery when the insured is recovering from a hospital procedure.

They may even have a cash-back feature that eliminates the $148.50 taken out of the insured’s Social Security check.

Most people on Social Security notice $148.50 per month. They find budgeting for hearing aids, dentures, and glasses difficult. And who doesn’t want a free ride and a free meal?

The tragedy is that the ads don’t reveal the other side of the story.

These plans offer hospital coverage through a limited number, sometimes just one, hospital system in the patient’s immediate home area. They wouldn’t, for instance, cover admission to a NeuroPsychiatric Hospital in another state. They usually do not cover any specialized neuropsychiatric hospital facilities, and they don’t cover all of the ER care.

For your free ride to the doctor, you may wind up with tens or hundreds of thousands of dollars in bills for neuropsychiatric hospital care, if it’s available at all.

Every NeuroPsychiatric Hospital is more easily accessible to patients on “Medigap” plans. These plans cost more, and many patients can only enroll in them during their first year on Medicare. But they are accepted everywhere that Medicare is accepted, and they make the process of admission to a NeuroPsychiatric Hospital much easier.

At NeuroPsychiatric Hospitals, we know these issues are complicated. We’re here to help. Contact us with your questions online, or call us at (574) 277-2630.