Going to the Hospital: Are You Being Admitted or Under Observation?

This is an important warning to all people on Medicare and their families: Know your status if you have to go to the hospital. According to the AARP, a growing number of patients on Medicare are being brought into the hospital and classified as under Observation instead of being admitted. They receive the same care and the same privileges as an admission, but there is a major difference beyond semantics.
Patients under observation get their coverage under Medicare Part B instead of Medicare Part A (hospital). This means that you can be paying more out-of-pocket expenses, including prescriptions used in the hospital. Further, should you need to go to a qualified nursing facility after your stay, Medicare won’t cover it!
What is worse is that the hospital doesn’t have to tell you your status until you are being discharged! The reason for this is that Medicare has been penalizing hospitals that have returning admissions. However, the loophole is to just put the patient under observation and they are not penalized. As usual, it comes down to money.
This means, you could spend anywhere from two days to two weeks racking up costs and fees thinking you are covered when you are not. So what can you do to avoid this trap or at least seek some retribution? The AARP provides some help:
You or your medical contact should ask about your status each day you are in the hospital. The hospital can retroactively change your status at any time.
If you are under observation, ask your hospital doctor or your primary physician to have it changed. If they are unwilling to do so, you can speak with the hospital committee that decides the status. You are able to ask why you are not considered as an inpatient.
If you need rehab after your hospital stay and then learn that Medicare will not cover it because of your hospital status, you can get home health care that is covered through Medicare or be directed to a Medicare-approved rehabilitation hospital.
You can always appeal to Medicare to reverse their decision. Keep all papers sent to you by Medicare and look for the proper procedure to make the appeal.
If you have any questions regarding your hospital visit or in need of help setting up an appeal, feel free to contact us at the Kabb Law Firm (216) 991-KABB (5222).