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Patient statuses and Medicare coverage

How the observation and the inpatient hospital status can affect Medicare Coverage

When you lay in bed wearing a hospital gown in the bed of a hospital room you would think it’s logical to assume you’ve been admitted to the hospital. Yet this is an assumption which can be wrong. You may be in the hospital under observation status which my drastically affect the coverage you have during and after your time in the hospital. Understanding the difference between the type of status being inpatient or observation is important to know.

Hospital Observation Status:

When in the hospital emergency room or coming into the hospital for outpatient surgery, X-rays, lab tests, or any other services; then most likely this is an observation status. The hospital stay could be overnight or several days to complete tests and you could still be under observations status instead of inpatient. Without doctors written orders to admit you into a hospital, your patient status is considered observation. Being admitted into a hospital requires complex medical decisions that doctors often need tests to be completed prior to addressing medical issues properly to make this decision.

Hospital Inpatient Status:

Once a doctor has written the order for admitting you into a hospital, you are then considered inpatient. In most instances when your expected to stay for two or more days for medically necessary hospital care; the status is inpatient. When you count days stayed in a hospital, day one considered to be the first day you are formally admitted into the hospital, yet the day the hospital discharges you will not be considered a full day.

Why is Hospital Status Important?

There are two main ways patient status my affect your insurance coverage. When you’re in the hospital under observation status, the fees are treated differently. As an example; Medicare Part B covers observation services, yet you are charged co-payments for each individual service unless you have additional Medicare supplemental insurance which might cover the co-payments.

Status can also affect the level of care that follows your hospital stay. Medicare only covers care following a hospital stay if you’ve been a inpatient for 3 consecutive days or more specifically 3 consecutive midnights. The post-hospital care covered is for post-hospital rehabilitation centers or skilled nursing facilities. Any days spent in the hospital under a observations status do not count as part of the 3 day minimum.

Questions to ask about your status:

A reasonable question to ask while staying in the hospital is “what my status is.” First question you should ask is “am I in the hospital as inpatient or observation status?” If you are placed in a room, don’t assume you are admitted as inpatient status. Second question that should be asked is “how long my stay in the hospital is expected to be?” While the answer is most likely to change, the question should still be asked. Lastly, always ask if specialized skilled services or rehabilitation services will be required once you leave the hospital. This information will allow you to plan in advance; with few surprises later.

Patient Rights:

A busy hospital staff may be intimidating but you do have the right to information about the care your receiving. To start, you should have an understanding of the type of treatment options available an be permitted to be a part of the treatment decision making process. You should have an understanding of what your coverage will be for services and prescriptions under your Medicare and additional health care insurance. Lastly, if you do disagree with any decisions, you may ask for a review. If you do feel your being discharged too quickly or if your care is not what you expect it to be then you’re entitled to discuss this with the hospital staff.