inpatient vs observation

When you go to the hospital and have to stay overnight, you assume you’ve been admitted to the hospital. But, depending on your health care needs, you may only be “under observation” as an outpatient.   A law passed in 2017 called the “Notice Act” requires hospitals to notify patients within 36 hours of putting someone on “observation status”.

Thanks to a complex system of rules and regulations for hospitals, providers, private insurers and Medicare/Medicaid patients, you can be in the hospital for several days – but be classified as an “observation” outpatient. Which means you’re not officially “admitted as a patient”.  The financial results are mind boggling.

Observations status is billed on an outpatient basis, not under the hospitalization or Part A Medicare, which pays all but 20%.  And the big kicker, Medicare will not pay for Skilled Nursing.

In Collin County, you are looking at 6-10K per month, private pay.   Don’t wait for the hospital to tell you, ask the following questions:

Am I being admitted as a patient or under observation?

How long do you expect I will be here?

Will I need Skilled Nursing Care or Rehab when I leave?