Know what Observation Status means before leaving the hospital

KETK
News

POSTED: Wednesday, March 5, 2014 - 6:55pm

UPDATED: Wednesday, March 5, 2014 - 7:48pm

Hospital visits can be short-term or long-term, but when doctors say further testing is needed some don't know what that means and that can lead to bigger medical bills.

When folks go to the hospital they expect to be in and out. Whether it's serious or minor some end up stay a little longer.

"Observation status is a quick observation and it rarely lasts more than 24 hours," said Stan Weiner, MD at Trinity Clinic Electrophysiology .

Dr. Weiner says, in the old days either you were an in-patient or out-patient. In-patient meaning being hospitalized and out-patient being treated in the clinic. Now, there's the term 'Observation Status' that leaves many people leery because the bill can be costly.

"Observation status was designed to address the needs of the patients, it's a way of rapidly and effectively figuring out if the patient is sick enough to stay in the hospital for longer periods of time for more invasive testing," said Dr. Weiner.

Folks we spoke to say they know first hand, many times they go to the hospital for pain and they're advised to stay for testing and then they receive an expensive bill in the mail. Those are some questions many people have. They want to know how long will they stay on the hospital, for exactly what, and how much it will cost.

Dr. Weiner says, typically the cost of the observation will be less than an in-patient stay. He says, using the observation status method is a successful way to treat patients. "It's used in a number of different disease conditions."

He says he understands why some patients worry more about making a financial decision than a medical decision. "It's a real fact of life that patients do need to consider the financial implications of treatment or not treatment."

Trinity Mother Frances Hospital provided more information on 'Observation Status' which includes insurance and billing information. Read below:

Hospitals may provide "observation care" for patients who are not well enough to go home but who may not meet medical necessity criteria for an inpatient and/or acute care admission. This care requires a Physician's order and is considered an outpatient service, even though patients may stay for up to 48 hours The hospitalization can include short-term treatment and tests to assist Physician's in determining whether the patient should be admitted or can be discharged and followed further as an outpatient Medicare guidance recommends that this decision should be made within 24 to 48 hours.

What do I pay as an inpatient?

Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in the hospital.
Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20% of the Medicare-approved amount for doctor services after paying the Part B deductible.

What do I pay as an outpatient?

Medicare Part B covers outpatient hospital services. Generally, this means you pay a copayment for each individual outpatient hospital service. This amount may vary by service. Note: The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible.

 

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