Aging Parents: “In Patient” vs “Under Observation” — How Being in a Hospital Bed can Fool You

Does being in a hospital bed qualify Medicare-eligible seniors as In-Patient?

For some time now, we’ve been hearing about Medicare-eligible seniors who’ve been given “Under Observation” status when admitted to hospitals–for what any intelligent person would assume should be “In-Patient” status. “Under Observation” status is not “In-Patient.” 

If parents need to enter a skilled nursing facility or a nursing home after the required three days of hospitalization, Medicare will not pay and the family will be required to pay all of the bills, including the hospital costs, if hospital status was “Under Observation.”

We might also assume that those in a bed in a hospital are automatically considered “In-Patients.” Not true. Hospitalization for those designated “Under Observation”–even if they’ve been lying in a hospital bed for the three days before going to a skilled nursing facility or nursing home–does not qualify them for Medicare reimbursement. 

If this is news to you, you’ll want to click on this February 6, 2014 FoxNews. com article with video. It explains the factors contributing to the admissions status problem, as well as the many difficulties with the appeals process experienced by “Under-Observation”-Medicare-enrolled patients, who were denied reimbursement.

There is a key word in the first two paragraphs: assume.  Sr. Advisor R, as readers know, is amazingly wise about handling life and will be 101 in September. Her wise words were the subject of an earlier post.  “Don’t Assume” is an example of R’s wise words. Perhaps that’s one reason she has navigated the challenges of life so well.

May the FoxNews link help all Medicare-eligible seniors and their caregiver children to better navigate the hospital-admissions-status challenge and all that follows.

Personal note: My Tuesday, Saturday posting schedule is still ify, so my goal of one post a week remains for the time being. My out-patient procedure in the hospital this past week (no bed involved) prompted this post when I learned that some of my “learned friends,” who are on Medicare, were clueless about the important bed nuance.

Changing often: “Of Current Interest” (right sidebar near bottom). Links to timely information and research from top universities, plus some fun stuff–to help parents age well. (Note 5/17/14 addition from Harvard Medical School for Caregivers)


2 thoughts on “Aging Parents: “In Patient” vs “Under Observation” — How Being in a Hospital Bed can Fool You

  1. My wife has Humana Gold Plus (HMO): Her Dr has suggested she get a Bone Density [Bone Mass Measurement]check. She had this done a year ago. In your 2012 Member Benefit Package book under Preventive Services , Item 23, under Original Medicare it staets -Bone Mass Measurement. Covered once every 24 months . While under adjoining column Humana Gold Plus H1406-022 (HMO) Bone Mass Measurement it makes no mention of the once every 24 months restriction.My question: Is she covered under this insurance if she opts to have this test, or does she have to wait until the 24 months since her last test to be covered?Also, her primary Dr has also requested she undergo a Colonoscopy.My question: Does she require a referral to be covered.?

    • I take it your wife has 2 medical insurance policies. Which is the primary insurer? Always check with the primary insurer first. They pay first. (To be safe, check out coverage for any procedure with your primary insurer.) Usually bill automatically goes to the secondary insurer who sees what the primary insurer has paid) The secondary insurer usually picks up part of the remainder, minus deductible (if not met) and the co-pay.You know Medicare’s guidelines for bone density testing. Ask your wife’s doctor why another bone density test is being suggested so soon. Is he/she aware one was done a year ago? There may be circumstances that warrant it. Good luck.

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