Be aware of your status if you are admitted to a hospital

Michelle Ungvarsky
Michele Ungvarsky of Estrada Law is an estate planning attorney. She can be reached at 556-2462.
Medicaid is the health insurance the majority of people over the age of 65 rely on for payment of health care. However, did you know that if you are admitted to a hospital for “observation,” Medicaid will not pay for the hospital stay?

There is a recent Federal law that requires hospitals to alert Medicare patients if they are admitted for “observation,” but what does that mean? Say you are feeling sick, you have waited, convinced that you will get better, but now you know you need help. So, you go to the local emergency room. Yup, you are too sick to go home, but not sick enough to be admitted. The health care provider may suggest that you be admitted for observation care so they can run some tests, give you medication, and try to figure out what is wrong. Guess what? This observation period is considered outpatient care and you as the patient will be charged for your share of the cost of each test, treatment, and other services you receive while you are in the hospital.

To complicate matters more, if the health care provider decides you will need to go to a rehabilitation hospital or nursing home to recover your strength, Medicare will not pay. Why? Because the Medicare regulations require a prior hospital admission of at least three consecutive days. Yikes! This is important because Medicare generally covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted to the hospital and an inpatient for at least three days.

There are legitimate reasons to admit patients for observation. Observation visits are less expensive for patients than a regular hospital admission if they stay for a short time. It also allows health care providers to perform tests and treatments to aid in the decision on whether to admit or send the patient home. Moreover, if patients are discharged quickly, they are more likely to go back to independent living as opposed to needing to go to a nursing home for care.

The new law requires hospitals to let you know if you are on observation status if you are under observation for more than 24 hours. The Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, requires notice within 36 hours or upon discharge if that occurs sooner. So, the message here is beware! You could be notified after a day and one-half of care and face extraordinary bills. Be an informed consumer of medical care, ask questions about your care and treatment or the care and treatment of your loved one. Do not allow nasty surprises.

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