Page 10 - Marysville Tulalip Life Magazine Fall 2017

Admitted or Under Observation?
10 Fall 2017 Marysville Tulalip Life
By, Ashanda Haley
It is difficult for seniors and their families to protect themselves against this risk as Hospitals are not required to notify patients that they’re under observation status and not formally admitted. What determines whether a patient is classified as admitted or observation? Usually the hospital makes that call, and in many cases this call may overrule the patient’s own physician.
Hospitals are placing more and more seniors under observation status to protect themselves against new policies that penalize hospitals for unnecessary admissions and readmits of the same patients. There are a few things you can do if you find yourself staying at the hospital.
If you have questions or would like more information that explains the observation-status issue in detail, go to www. bit.ly/KTa5LJ
Recently, a resident at Windsor Square Retirement Community spent six days in the hospital with extra fluid around her heart. She was in a room, with a hospital bed, wearing a hospital gown, had an ID bracelet, she was eating meals, and receiving care from doctors and nurses. Nothing alerted her or her family that she was not formally “admitted” into the hospital. It was at discharge that she and her family found out she was under “observation”.
This small word would cost her thousands of dollars. When a patient who meets Medicare’s three-day formal admission requirement moves to a skilled nursing facility, the program covers 100% of the first 20 days. Then after the 20 days, if they still need the care of a skilled nursing facility, the average fee will be around $152 daily co-pay for up to 80 more days.
In this case, the resident found herself leaving the hospital under observation status. This means that Medicare will not cover any of the skilled nursing cost or her hospital stay. The average daily rate to pay privately is $230 a day and costs can go higher. If she was a low income senior Medicare would pay for all costs. She is not low income and all the hospital fees and skilled nursing fees were billed directly to her.
• Ask about your status daily.
• If you are under observation, ask if they will re-evaluate
your case to be admitted.
• After you are discharged, if you find yourself needing
skilled nursing and you were under observation, ask your primary care doctor if there are similar care options you can qualify for at your home.
• If you do have to go to skilled nursing after observation status, you can file an appeal to Medicare. Once you receive your bill, highlight the costs and send a copy of it to the address the statement came from.