Friday, September 20, 2013

Ooops, you just thought you were admitted

Susan Jaffe, Kaiser Health News, Sept 4, 2013, has a warning for Medicare users. You may go to the ER, get tests, even go "upstairs" and stay a few days, but you may not really be admitted to the hospital--and therefore you may be liable for big bills.

It's called Hospital Observation Care.

More Medicare patients end up with this status each year--1.6 million in 2011.

This happens when you are not well enough to go home, but not sick enough to be admitted. So on a doctor's order, you stay for observation. This can last more than 24 hours.

This is considered an outpatient service--you may get copayments for each doctor fee and each hospital service. Yow!

Also, if you need Medicare coverage for a nursing home, you may not get it if you were in the hospital in this status.

Hospitals like this because if you return within 30 days, they don't get docked--you were never admitted in the first place.

How do you know--in the fog of sickness--where you are on this status--ASK!!! Medicare does not require hospitals to tell you. If you are on Observation Status, the doctor can request in-patient, but the hospital does not have to comply.

Trying to challenge it later is a nightmare. So heads-up.

There are bills in Congress to correct this...There are always bills on everything.

2 comments:

Anna Maria said...

This is interesting, I had never heard of it and I am on Medicare. I have been to the E.R. twice in extreme pain with blood in the urine that could never be determined what the cause of was. After every test in the book came up negative, I live in fear it will return again because I have twitches in my lower right side where it originated from. They refuse to consider it might be a failed mesh bladder life I had five years ago telling me no scan or x-ray can detect those. They just prescribe pain killers and send me home to worry. Believe me, I do. So far I've only had to pay the ER co-pay but the scenario you describe now only gives me reason to worry more when I have a "twitch."

Star Lawrence said...

Better to be informed. I guess. Sometimes I think I am informed of too much stuff. Once, with Mom, they kept her overnite in the ER against our wishes, they said there would be a bed (I stayed till midnight)--and I kept insisting to know was she admitted or not. They said she was. As for your pain, I am not a doctor, but some of those meshes are trouble--I would get a second opinion. And you know I don't say that lightly.