Health & Wellness / Medicare

Inpatient, Outpatient, or Observation: What is my Status?

observation inpatient outpatient hospitalHospitalization is not only a scary time, but can also be a bit confusing to many patients. You may be under the impression that just because you have spent a day or two in the hospital, you are admitted. However, this is not always the case.

Doctors in the emergency room may place a patient under observation status. For example, if you go to the hospital with chest pain, you may not be officially admitted but rather held for observation while doctors perform the necessary tests.

When it comes to Medicare insurance, the status of your hospital visit is important. Bills incurred during observation status will be paid by Medicare Part B (outpatient care), while an admitted patient will be covered by Medicare Part A (hospital care). Additionally, any follow-up care, such as skilled nursing care, may not be covered by Medicare at all after being hospitalized under observation status.

While you are hospitalized, it is important to communicate daily with your doctors, nurses, and other hospital staff regarding the status of your stay.

If you have any questions please call AMAC’s Medicare Department to speak to one of our Trusted, Licensed Insurance Agents.

Call 1-800-334-9330 or Get Quote

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5 years ago

Obamacare changed the incentives / disincentives model for hospitals regarding whether to or not to admit a patient and if so under what status and for how long a hospital stay was allowed depending on the illness or procedure being done. New federal guidelines were issued for all procedures and illnesses as to how the patient was supposed to be handled if the hospital expected reimbursement for treatment and services performed. Just one of the many terrible outcomes that was the result of Obama being re-elected in 2012 and Obamacare going into full rollout. The mountain of faxes and e-mails from D.C. announcing all the various Obamacare changes going into effect immediately came days after the election. So elections do have consequences.

Good to see you’re at least trying to explain these admission distinctions at a high level, as it seems the average person still may not know how the rules have been changed and how being admitted under the wrong classification or over-staying the allowed timeframe can result in very substantial medical bills not covered by Medicare / Medicaid.