Are you a Medicare enrollee? If so, ask this question the next time you visit a hospital for care: “Am I admitted, or am I here for observation?”
Failing to do so could potentially cost you thousands of dollars.
That’s because if the hospital deems that you are at the facility “for observation” — also referred to as you being an “outpatient” — Medicare will not pick up the tab for certain hospital services. Nor would Medicare pay for care you receive in a skilled nursing facility if you need to go to such a facility after leaving the hospital.
To get Medicare coverage for hospital services like X-rays and lab tests, or for care in a skilled nursing facility, you first need to be “admitted” to a hospital. This is also referred to as you being an “inpatient.”
Margie Barrie, an insurance agent with ACSIA Partners, knows the potential danger of making the wrong move. She recently wrote a piece for ThinkAdvisor about the day her 98-year-old mother was taken to an emergency room with what turned out to be congestive heart failure.
Eventually, Barrie’s mother was told she was being moved to a hospital room. Barrie recounted how a hospital employee approached Barrie’s mother with several papers to sign, saying the forms were routine:
“The first paper is about authorizing Medicare to pay the hospital bill.
The second paper — and this is done very smoothly — states that my mother understands she will be in the hospital on observation status for 24 hours.
As my mother is handed the paper to sign, I shout, ‘Mom, don’t sign it!'”
Barrie says various members of the hospital staff tried to browbeat her mother into signing the forms — at least until Barrie uttered some magic words: “I write a column in a national newsletter that has a large circulation.”
After a bit more debate and discussion about whether Barrie’s mother had been given oxygen in the ER — she had been — her mother’s hospital status was changed from “observation” to “admitted.”
As it turns out, Barrie’s mother did end up going to a skilled nursing facility for physical therapy and rehabilitation after leaving the hospital. Had Barrie not pushed to get her mother’s hospital status changed while her mother was at the hospital, the stay in the nursing facility would have cost $650 a day — out of pocket.
Barrie’s parting words of advice to others who find themselves — or loved ones — in a similar situation are as follows:
“Know these rules so that you can challenge them if appropriate. This discussion must occur in the emergency room. The reason is that when the patient leaves the emergency room, you cannot get the status changed.”
To learn more about the rules that determine whether someone’s Medicare hospital status is observation or outpatient versus admission or inpatient, you might want to start by reviewing Medicare’s “Are You a Hospital Inpatient or Outpatient?” handout.
Looking for more ways to save on Medicare costs? Knowledge is power! So, check out Money Talks News’ latest Medicare coverage.