Seniors, Check to Make Sure You Are Not Being Observed

Nancy Schfield, Advocacy Chair for  Elder Net in Bryn Mawr, recently wrote an  article about this issue in the Elder Net Newsletter. It seems a local resident was surprised by unexpected medical bills. The topic was also addressed in a recent newsletter of the National Academy of Elder Law Attorneys, and it was further discussed at a meeting of the Elder Law Section of the DELCO Bar.

It does not happen often, but a senior who is enrolled in Medicare might visit the emergency room of a hospital, and the hospital is not yet certain there is a medical condition that requires care, so the hospital keeps the patient for “observation.”

During the “observation” period, a physician will monitor to determine whether to admit the patient or instruct them to return home. Examples of conditions that might be monitored under “observation” are: nausea, vomiting, pain in the chest, back or stomach, headache and/or some breathing problems. However, a patient may be placed in outpatient observation following a complication of an outpatient surgery or proecdure.

Under Medicare guidelines, the observation may not usually last longer than two days. There is a difference in the Medicare benefits provided depending upon whether a patient is admitted or held for observation. If admitted, billing is under Medicare Part A which covers hospitalization.  If held for “observation,” this is covered under Medicare Part B, and therefore there may be deductibles, co-pays and co-insurance.  The amount of these other charges may also depend upon Medigap policy coverage.

There are even more ramifications. If given medication by the hospital during the course of the “observation” that could be self administered in another setting, the cost of those medications is not covered by Medicare. This might include tablets, sprays, drops or inhalants. The hospital willl directly bill the patient for those.

Even more importantly, days in “observation” do not count toward the three day Medicare qualifying stay needed to be eligible for home care or rehabilitation in a facility.

Therefore, seniors, if a physician in the Emergency Room of a hospital tells you that (s)he wants to keep you at the hospital, be sure to ask whether you will be admitted, or be on observation status. The difference could be costly to you.
 
If you have any questions, concerns or stories about your experience in this topic, please leave a comment below.

Stay well until the next post,

Bob Gasparro