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Three Days in the Hospital and
Still an Outpatient!
Three Days in the Hospital and
Still an Outpatient!
Cindy Dubansky, MSW, LICSW C-ASWCM
How is this possible? It is because of “Observation” status, a classification that most people do not know exists. In addition to Inpatient and Outpatient, the hospital can also classify your care as Observation status, which is actually another Outpatient classification for insurance purposes.
Hospitals use Observation status when your medical situation does not initially appear to meet criteria for admission as an Inpatient and your doctor needs to determine the need for further care or Inpatient admission. Your doctor decides the status. You receive the same care from hospital staff regardless of your classification.
Observation status can affect how your hospital bill is covered by your health plan. Each health plan may cover it differently. Only Medicare coverage will be addressed here.
When you are covered by Medicare, Observation status can also affect whether Skilled Nursing Facility (SNF), like short-term rehab, will be covered when you are discharged from the hospital. Medicare requires a three-day Inpatient hospital stay (among other requirements) to qualify for coverage of SNF. Even if you are in the hospital for three days, if any part of it was Observation status, Medicare will not cover a SNF stay for you, since Observation status is considered an Outpatient classification. Private pay in SNF can cost thousands of dollars, including an upfront deposit that can run $1500 to $5000.
If Medicare is your primary coverage, Observation status is covered under Medicare Part B. Thus, you may be responsible for out-of-pocket expenses, including the Part B deductible if it has not been met, a 20% coinsurance for each hospital service, and drug charges. Medicare Part B covers only very limited medications, so you may be billed the hospital rate for medications and for the hospital staff to administer them.
If you have Medicare supplement coverage, your supplement plan may cover the deductible and coinsurance charges according to the plan contract, but will likely not cover the drug or drug administration charges. These charges alone can run hundreds or thousands of dollars, depending on what drugs you are given and how long your care is classified as Observation status. Medicare limits how much the hospital can charge for any single outpatient hospital service on Observation status, but not the total of all the individual services.
Observation status has existed for several years, but is now used increasingly often in Minnesota and all over the country. Many Minnesota hospitals provide a written notice to patients who are admitted on Observation status, but you may not realize until discharge or until you receive the bill that your hospitalization was Observation status and the impact on your wallet.
There are valid medical reasons to be admitted on Observation status, but what can you do about your status? Ask questions!
When you are being admitted to the hospital, ask your doctor whether your status is Inpatient or Observation. If it is Observation status, ask why.
While you are in the hospital on Observation status, ask your doctor every day whether it can be changed to Inpatient status. If not, ask why not.
If necessary, ask the hospital’s patient advocate, usually called a Patient Representative, to help you clarify your status or get your status changed.
Consider asking a family member, friend, or other person to be your advocate.
If you feel Observation status was used inappropriately in your situation and you want to appeal the decision, contact:
Kelli Jo Greiner, Minnesota Board on Aging.
PH: 651-431-2581
Email: Kellijo.greiner@state.mn.us
Cindy Dubansky, MSW, LICSW, C-ASWCM is the President of Care Management Solutions, LLC, providing care management and health care advocacy services for seniors, people living with a disability or chronic illness and their families.
Care Management Solutions, LLC
PH: 612-308-0166. Email: info@caremanagementllc.com.
Website: www.caremanagementllc.com.
December 2010
Copyright © 2010 Cindy Dubansky, MSW, LICSW, C-ASWCM. All Rights Reserved.
Friday, January 28, 2011
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