A recent Medicare trend has many seniors and their families very concerned. Those not in the know could pay several thousand dollars more than expected for treatment. The devil is in the details of the terminology related to admission classification.
Alice’s recent experience, for example, didn’t turn out as expected.
Alice, one of our dear clients, was admitted to the hospital for a respiratory related condition. She had a reasonable expectation to be covered by her Medicare plan, as she had previously been covered for treatment by the same doctor and hospital.
She occupied a hospital bed for two days, getting the same caliber of care as before. She was visited by the same doctors and nurses, who took her pulse and blood pressure. She answered their questions as usual and took her medication with breakfast, lunch and dinner.
Alice felt much better when she was released, until she saw the bill. The charges were shocking. She was certain that something must be wrong. It wasn’t a case of mistaken identity, but a classification called “observation care” that was behind the surprise. It’s also known as “admittance under observation.”
Observation Care – You Must Be Aware
Observation care is a classification being assigned to Medicare patients with increasing frequency. It’s hitting seniors in the wallet, sometimes pretty hard.
Because Medicare views observation care as a form of outpatient service, patients do not enjoy the same level of coverage. The general idea behind the classification is that it’s used when a patient is not well enough to go home. Neither are they sick enough to be admitted to the hospital in the traditional sense. Think of it as a treatment and observation period to determine whether the patient’s condition meets the requirements for actual admission.
Medicare patients need to be aware of the practice and be prepared to ask questions and take action. It could result in significant savings.
Be Proactive – Know Your Admission Status
You might not always be able to avoid observation care altogether. There are, however, several things you can try, in order to help yourself.
Consult your Medicare plan: Learn about the plan’s specific rules related to observation care or, as otherwise known, admittance under observation.
Ask your doctor: Find out which classification will be used. Are they planning to have you admitted for observation or truly admitted as an inpatient? If you’re going to be admitted for observation, ask about the reasons, and whether you can get inpatient status instead.
Inquire daily: During your stay, your status can change on a daily basis without you knowing about it. If you are notified, it very well may be after the fact. If you’re changed from inpatient to observation care, make a request for the hospital to reconsider.
About Your Meds When In The Hospital
Medications administered under observation admittance do not enjoy the same Medicare coverage as those with inpatient classification. The difference can cost you a great deal. And you can’t always count on them letting you bring your normal medications from home.
Nursing Home Coverage Can Be Impacted
Your hospital classification has an impact on Medicare coverage for nursing home care. In order for nursing home care to qualify for Medicare coverage, the hospital stay has to meet the “three midnight” rule. You must stay overnight for three consecutive days. Observation care does not count toward that rule.
Pay Attention To The Moving Target
Healthcare and Medicare rules and practices are constantly changing. What that means for seniors and their families is that they have to pay more attention to the latest trends. That can be done by attending seminars and asking questions of trusted professionals like your doctor, attorney and financial advisor.