Are you really in the hospital?
More and more Medicare patients are finding themselves hospitalized under “observation” status rather than being fully admitted.
The care is the same. The ailments can be the same. And, sometimes, even the stays are the same in length.
The bills are vastly different.
Observation status is considered outpatient care, Part B, and is subject to 20 percent cost of services and the deductible. In addition, if a patient isn’t admitted, he or she isn’t eligible for nursing home coverage upon discharge.
The number of patients nationally admitted under observation increased 88 percent between 2006 and 2012, Kaiser Health News reports. Hospitals have blamed Medicare rules for the rise; Medicare won’t pay the hospitals’ claims if the government insurer believes the patient didn’t warrant admission.
How do you know if you’re admitted? Ask your care team. Most states, including Florida, don’t require hospital officials to disclose your status, although the Florida legislature is considering bills to change that.
Local news reports offer insight into policies at Lee Memorial Health System and NCH Healthcare System. You can read those articles here and here. Kaiser Health News offers this FAQ explanation of observation vs. inpatient care.
For help with your medical bills, or to appeal your Medicare claim, visit the Center for Medicare Advocacy.