HOW HOSPITALS FLEECE PATIENTS BY GIVING THEM OBSERVATION STATUS

 

NBC NEWS had a segment yesterday exposing how hospital administrators pressure doctors to give arriving patients "observation" status instead of "in patient" status.  It all comes down to money and a lot of it. 

 

Although the doctor won't tell you, as in patient Medicare pays. Under observation status, you pay.  And the amount can rise to tens of thousands of dollars.

 

For someone aware of this method of extracting money from patients, it can also amount to an exhausting argument with your doctor, at a time when you are scared and in pain.

 

Read more and watch interview with the wife of a patient. 
http://www.nbcnews.com/nightly-news/how-avoid-two-words-cost-thousands-medicare-bills-n38281

More on the "Observation" Status 

How Hospital Observation Status Can Cause Trouble for You

It Can Cost You More Money and Prevent You from Being Admitted to the Hospital

 

Hospitals have figured out a sneaky and unethical new way to make money, putting patients at risk both financially and medically. They are using what used to be a good way to help patients who didn't really need to be admitted to the hospital, called "observation status," as a way, instead, to game the system. It is costing patients money out of their pockets and from their taxes, and could possibly affect their medical outcomes, too.

 

When patients go to the emergency room, a determination is made about whether they should be admitted to the hospital or not. Some patients are simply sent home with some sort of prescriptive treatment. Others are admitted right away because they will clearly need surgery or some other form of treatment (the hospital can charge for). Others may either be borderline, or they may need treatment for a short period of time, although that "short period of time" can range up to a week or more.  It's those patients who may be put on observational status, probably should not be, and will be hit in the pocket later for extra costs they would not incur if they were, instead, admitted to the hospital.

What can you do to prevent yourself or a loved one from being placed on hospital observation status?

This question has no easy answers. Short of avoiding the emergency room all together, there isn't much you can do to protect yourself or a loved one from being placed on observation status.

However!  You may be able to get yourself or your loved one admitted to the hospital instead, saving those tens of thousands of dollars. 

• Be fully aware that you do not want to be held at the hospital on observation status. Even though it might sound even marginally appealing because it sounds temporary (and you think you might return home quicker), know that there are really no upsides to observation status.
   
• Contact your primary care doctor before heading to the emergency room. He or she will advise on whether you have alternatives to the ER. Further, if you do have to go to the ER and stay at the hospital, you should be able to enlist your doctor to help you be sure you are fully admitted.
   
• Ask to see the paperwork which shows you have been admitted. If you see the word "observation" then ask to speak to the person who will fully admit you - and be assertive if you need to. You may need to find a hospital administrator - and don't be afraid to argue about it.
   
• If you are afraid to speak up, or if you need support in any way to change status, contact a patient advocate to help you.

It bears repeating:  even if you or your loved one is not a Medicare patient, double check with your payer to be sure a hospital stay is covered - observation status or not.

Read more - http://patients.about.com/od/rightsresponsibilities/a/How-Hospital-Observation-Status-Can-Cause-Trouble-For-You.htm


Why should observation status v. inpatient status matter to me?

 

If you’re an inpatient, but Medicare or your health insurance company determines that you should have been assigned observation status, it can refuse to pay for the entire inpatient hospital stay. You probably won’t discover this until the hospital has submitted the claim and had it denied by the insurance company weeks or even months after your hospitalization.

 

But, if you’re assigned to observation status rather than inpatient status, although it’s less likely your insurer will deny your entire claim, you’ll still take a financial hit. Usually, your share of cost for outpatient services is larger than your share of cost for inpatient admissions.

 

Since observation patients are a type of outpatient, their bills are covered under Medicare Part B, or the outpatient services part of their health insurance policy, rather than under the Medicare Part A or hospitalization part of their health insurance policy. Outpatient coverage usually has higher coinsurance rates than inpatient coverage. So, you’ll end up paying a larger portion of the bill for observation services than you would have paid for inpatient services.

Read more - http://healthinsurance.about.com/od/claims/a/Hospitalized-In-Observation-Status-Youll-Pay-More.htm

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