It seems that it’s in the winter months when people I know are more likely to go to hospital as an emergency patient so I thought this was a good time to write about an aspect to hospital stays that you may not know about. I was reminded about it when I read Paula Span’s October 29, 2013 article in the New York Times Health section, Two Kinds of Hospital Patients: Admitted, and Not. She also wrote a similar article in June 2012 In the Hospital, but Not Really a Patient.
There are many stories about elderly people in particular who have been cared for in hospital for several days, in a hospital bed, and eating hospital meals, only to learn when they are discharged that they were never admitted. Instead, they were being observed and were considered to be an outpatient. From the patient’s perspective, it might be difficult to distinguish their status – admitted or observed – but the difference becomes an issue once the patient is discharged in at least two ways:
- How the hospital bill will be paid, for patients eligible for Medicare
- If you have been admitted to the hospital, your stay will be covered by Medicare Part A (hospital coverage).
- If you were under observation only, you are considered an outpatient and Medicare Part B (doctor coverage) takes effect. You will be responsible for higher copays.
- Whether Medicare will cover the rehabilitation and skilled nursing care once the patient has been discharged
- If you have been admitted to the hospital, and have received 3 consecutive days of inpatient care, Medicare may cover your bill in full for up to 20 days.
- If you were only under observation, you will be responsible for the entire bill.
There is more information in this pamphlet produced by Medicare: www.medicare.gov/publications/pubs/pdf/11435.pdf (PDF)
In the second article, In the Hospital, but Not Really a Patient, the author notes that the number of elderly patients who are detained in the hospital with observation status is increasing as is the length of stay under observation. These practices have been happening for many years.
How do you know whether you were admitted or observed? Apparently, the hospital does not need to tell you (except in New York state), but you can ask. I would also suggest that you get your reply in writing.
Patients are people, too!
Both articles referred to the Center for Medicare Advocacy: www.medicareadvocacy.org. I found a lot of good information about the admission/observation issue there. There are self-help packets to expedite appeals, and opportunities to take action to help affect legislation.
Another website that I was referred to and that I hope you find helpful is www.Medicarerights.org