Under Observation: What you need to know about your outpatient or In-patient status
In today’s world, some seemingly simple things have become more complicated. What is unfortunate is that seniors, who are more likely to be accustomed to the way things were in the past, become increasingly likely to fall through the cracks. One of the times when seniors are at their most vulnerable is when they are in the hospital.
You might think that being admitted to the hospital is pretty straightforward. However, a new problem as developed relating to the classification of patients while staying or being treated in hospitals, and how that impacts directly the cost of their subsequent care in nursing facilities. The question becomes: does the patient have inpatient or outpatient status? The answer could prove to be costly.
What’s the Difference Between Being an Inpatient or an Outpatient?
Outpatient treatment means that a patient has not been formally admitted to the hospital and is simply “under observation.” Those with inpatient status are officially admitted to the facility, and supposedly receive more intense attention from hospital staff.
In reality, these classifications are not clear cut in their differences. There is a great deal of overlap between the services provided patients under the two classifications. And to make matters worse, patients are not always aware of which status they are listed as officially.
Unfortunately, seniors may face great financial hardship if classified as outpatients while believing they are inpatients who have been formally admitted to the hospital. If a person requires subsequent care in a nursing facility, they are responsible for the cost of that care if they cannot show that they previously were admitted to a hospital for three consecutive days. If the senior can show, however, that they were admitted for three days, then Medicare will pay for the nursing home according to its regulations. This rule is not as widely known as it should be and has caused major financial problems for thousands of senior citizens.
What are some possible solutions to this problem?
First, it is helpful for anyone being treated in a hospital to ask daily about their patient status. American hospitals are notorious for refraining from telling people their status, so don’t be afraid to ask until you get an accurate answer. Second, if you ask to be admitted to the hospital and are refused, you should try to get your doctor to become your advocate. Many doctors do not agree with the Medicare rule either and are likely to help you, whether it is by writing a letter on your behalf or speaking to the hospital board that is in charge of determining which patients are admitted. Furthermore, many congressmen and women have issues with the Medicare rules as they stand, and there has been bipartisan support for altering them. It couldn’t hurt to contact your local congressperson’s office if you have concerns.