Admitted vs. Observation on Medicare

BluebirdOne

I had no idea the ramifications of being put under "Observation" rather than actually "Admitted" to the hospital. This is timely and crucial, and horrible for a family and cancer patient to be put through, made even worse by the fact that the father is an MD as is his son. 

https://khn.org/news/even-doctors-cant-navigate-our-broken-health-care-system/

Dr. Shanawani orginally told his story on Twitter, which I know few people use. His full and agonizing story is there, summaraized in the KHN article above. If you have a Twitter account his thread can be located at @hshanawaniMD.   I am sure than many here with a medical/hopsital background know this information, but many folks are not aware.

https://www.medicareadvocacy.org/medicare-info/observation-status/

https://www.forbes.com/sites/howardgleckman/2019/01/02/understanding-medicare-observation-status/#6a5678a17876

Denise 

 

Edit: I edited my title (borrowed from CMB) to add clarity. Thanks, CMB. 

 

cmb

Admitted vs Observation on Medicare

Denise,

Thanks for sharing this information. When my oldest sister had a medical emergency last year, my other sister, who had taken her to the emergency room, insisted the doctors "admit" her to the hospital once she was transferred to a room, rather than remain on "observation status."

Fortunately my sister knew to ask for this and the doctors obliged. Otherwise my oldest sister could have received some big bills as she remained in the hospital for a couple more days undergoing tests and treatments.

Definitely something to know about before an emergency occurs.

BluebirdOne

cmb said:

Admitted vs Observation on Medicare

Denise,

Thanks for sharing this information. When my oldest sister had a medical emergency last year, my other sister, who had taken her to the emergency room, insisted the doctors "admit" her to the hospital once she was transferred to a room, rather than remain on "observation status."

Fortunately my sister knew to ask for this and the doctors obliged. Otherwise my oldest sister could have received some big bills as she remained in the hospital for a couple more days undergoing tests and treatments.

Definitely something to know about before an emergency occurs.

Some of us have had repeated trips to the ER

and if they are Medicare this is important information to have.  

Denise 

MAbound

Frosts my cookies!

I've heard about this before but the class action lawsuit was news. Gets me that this has been going on for quite some time now. 

The other thing one has to look out for these days is insurance coverage for ED doctors and anesthesiologists. A lot of them don't take any insurance and even if you are at an in network hospital you can still get billed separately for the full amount those doctors charge. We've got that issue here with our Anthem Blue Cross. None of our in network hospital ED doctors take insurance. None. We checked with our insurance about this and we are SOL if we need to go to an ER. How crazy is that?!

Tamlen

MAbound said:

Frosts my cookies!

I've heard about this before but the class action lawsuit was news. Gets me that this has been going on for quite some time now. 

The other thing one has to look out for these days is insurance coverage for ED doctors and anesthesiologists. A lot of them don't take any insurance and even if you are at an in network hospital you can still get billed separately for the full amount those doctors charge. We've got that issue here with our Anthem Blue Cross. None of our in network hospital ED doctors take insurance. None. We checked with our insurance about this and we are SOL if we need to go to an ER. How crazy is that?!

ED?

I must be thick...ED doctor are what?

BluebirdOne

Insane. And scary.

Everyone is on salary where I go for my cancer care. It is too far to go for ER care so thanks for the heads up. I think I remember a NYT story a few years back where a guy had a $105k bill from the anesthesiologist, who was brought in as a substitute and was out of network for the guy and he was not even aware a substitution was made until he got the bill.  I am still not sure how things work with Medicare, as I thought that the doctors had to accept the payment that Medicare dictates, which relates back to the non-admission status of patients. 

Denise

abrub

Yes, if you're on Medicare and going to be held overnight

INSIST on being admitted.  It affects how/if any follow-up care is covered.

Forherself

BluebirdOne said:

Insane. And scary.

Everyone is on salary where I go for my cancer care. It is too far to go for ER care so thanks for the heads up. I think I remember a NYT story a few years back where a guy had a $105k bill from the anesthesiologist, who was brought in as a substitute and was out of network for the guy and he was not even aware a substitution was made until he got the bill.  I am still not sure how things work with Medicare, as I thought that the doctors had to accept the payment that Medicare dictates, which relates back to the non-admission status of patients. 

Denise

I have worked in a doctors office

and have dealt with some insurance.  This is the way Medicare works.  Doctors can choose to be part of medicare.  The payments vary greatly, and Family doctors are not paid very well by Medicare so many of them will not accept Medicare patients.  Specialists on the other hand are reimburses at a better rate.   MOST specialists accept Medicare.  It is a lot of their work.  So Medicare would cover most specialists.   IF you buy a Medicare Advantage plan, they are health maintainance organziations.  Or PPO's.  So the PPO manages your care. The doctors all have to sign on with the PPO.  A hospital signs on with the PPO.   That is how you can go to a hospital that is in your PPO and be seen by a doctor that is not.  The doctors all decide whether they will sign on with the PPO.   IF you buy a Medicare supplemental plan, you can see any doctor that accepts Medicare which is the vast majority.  And you can self refer.  In other words, just call and make an appointment.  I ahd a PPO and changed to supplemental.  My gyne oncologist did not contract with my new plan, but the hospital did.  Now I can see anyone.  But when we go to Canada I have to buy travellers insurance.  Supplemental insurance pays the difference between what Medicare pays and what the doctor or hospital charges.   We go to an insurance broker and they can explain the plans. 

BluebirdOne

Forherself said:

I have worked in a doctors office

and have dealt with some insurance.  This is the way Medicare works.  Doctors can choose to be part of medicare.  The payments vary greatly, and Family doctors are not paid very well by Medicare so many of them will not accept Medicare patients.  Specialists on the other hand are reimburses at a better rate.   MOST specialists accept Medicare.  It is a lot of their work.  So Medicare would cover most specialists.   IF you buy a Medicare Advantage plan, they are health maintainance organziations.  Or PPO's.  So the PPO manages your care. The doctors all have to sign on with the PPO.  A hospital signs on with the PPO.   That is how you can go to a hospital that is in your PPO and be seen by a doctor that is not.  The doctors all decide whether they will sign on with the PPO.   IF you buy a Medicare supplemental plan, you can see any doctor that accepts Medicare which is the vast majority.  And you can self refer.  In other words, just call and make an appointment.  I ahd a PPO and changed to supplemental.  My gyne oncologist did not contract with my new plan, but the hospital did.  Now I can see anyone.  But when we go to Canada I have to buy travellers insurance.  Supplemental insurance pays the difference between what Medicare pays and what the doctor or hospital charges.   We go to an insurance broker and they can explain the plans. 

Thanks so much for the clarification,

it is so difficult to know all the ins and outs of Medicare and insurance. 

Denise 

BluebirdOne

abrub said:

Yes, if you're on Medicare and going to be held overnight

INSIST on being admitted.  It affects how/if any follow-up care is covered.

abrub,

Is that a pileated woodpecker?  So cool!

Denise 

MAbound

Tamlen said:

ED?

I must be thick...ED doctor are what?

ED = Emergency Department

Sorry! I know medical abbreviations can be like alphabet soup!