You were required to stay in the hospital OVERNIGHT, but haven’t actually been “admitted” and Medicare isn’t covering the costs. WHY?  

You have most likely been placed in the gray area known as OBSERVATION CARE

Observation Care is an in-between status of patients who the hospital has determined “not well enough to go home”, but “not sick enough to get admitted.” Observation Services allow the doctors to keep patients under their care while assessing if further medical treatment as an in-patient is required, or if they should be discharged from the hospital. 

What is the difference between these statuses?

  • Inpatient Status
    • Patient is admitted to the hospital
  • Observation Care Status 
    • Patient is not “officially” admitted to the hospital, but placed under care and watch
    • Can included the same tests and treatments as people who are admitted
    • This status can last for several days / nights
    • Considered to be an outpatient service

If you are getting the treatment you need, why does the “status” of your hospital stay matter?

  1. Both your Medicare Coverage and health insurance will pay out differently (usually less) for Observation Care Services  than it would for Inpatient Services. This can include charges for hospital/doctors’ fees, co-pays, medications provided during your stay, and prescriptions suggested for after your stay. 
  2. If you are well enough to leave the hospital, but not healthy enough to go home, you may require follow-up treatment in a Skilled Nursing Facility / Nursing Home. *Medicare states that you must have spent at least 3  consecutive days as an ADMITTED patient to be eligible for coverage in one of these facilities.*  Since Observation Care status is classified as an outpatient service (no matter the length of time spent in the hospital), Medicare will NOT cover rehabilitation at a Skilled Nursing Facility / Nursing Home if you were never officially “admitted” to the hosptial. 

How can you tell what your status is?

ASK! While we’ve heard word of new laws being passed that will require the hospitals to notify you of what status they’ve placed you under, you can also simply ask them. Otherwise, there is essentially no other way to tell the difference. Some other things you can inquire about is how long they anticipate your hospital stay to be and whether or not they think that additional time at a Skilled Nursing Facility will be necessary. 

Planning Ahead…

Placing patients under this Observation Care status is becoming more common and unfortunately, it could happen to you too.

Rather than becoming one of the many beneficiaries who are receiving that unexpected bill in the mail, we urge you to plan ahead! At SBS, we have coverage options for this exact situation – ensuring you are always taken care of no matter when you require a trip to the hospital or what status they place you under. 

Call one of our agents today to see what your options are! As always, we’ve got you covered. 


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