BEWARE OF ER “OBSERVATION STATUS”

ER Observation Status

Traditionally, if you were relocated out of the emergency room (ER) to another room in the hospital and spent the night, you were considered “admitted” to the hospital. Unfortunately, that is no longer the case. You can be spending many nights at the hospital and still not be “admitted”. You may be classified as “observation status.”

Why does this matter?

Medicare specifically, as well as many private insurances, require a three day hospital admittance for insurance coverage for subsequent rehabilitation or skilled Nursing Care. Without the three day pre-requisite hospital “admittance,” you have no insurance coverage for the subsequent care. That means you are either going to have to pay for those services out of your own pocket or forego the services entirely.

Let me use my own situation as an example. A few years ago I was hospitalized as a result of acute back pain such that I could not stand, sit or even move in a prone position without triggering extreme pain. If I found a comfortable position (lying down), so long as I did not move, I had no pain. I was moved out of the ER to a room and tests were taken. After three days, they confirmed my suspicion that I had a herniated disc and prescribed oral steroids and inpatient rehabilitation therapy. However, unknown to me, I was in “observation status.” As a result, even though I could not go home because I could not get out of bed, and I was in the hospital for three days and I required inpatient rehabilitation services at a skilled nursing facility (SNF), I was told my health insurance would not cover it because I did not have the pre-requisite three day hospital “admittance.” Fortunately for me, the doctor then admitted me for an additional three days, I was then discharged to a SNF and my insurance paid for my care. Many are not so lucky because they do not understand “observation status” is different from “admitted” and the legal and medical implications that follow. Current law requires the hospital to inform you in writing that you are in “observation status.”

If this were your mother or father and they were in excruciating pain and the hospital gave them the disclosure required by law, would they understand it or, if they did understand it, would they care enough to argue with their doctor or insurance company to get this resolved before treatment?

 

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