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Old 04-22-2016, 07:58 PM   #1
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24 Hour Hospital Observation

Might want to read this.

Don't know where I first saw this but it took me a bit to get it confirmed.

If you go to the hospital with CP they often admit you to a 24 hour observation unit. This is done to get all the testing done and you out before the 24 hours are up so they don't do a full admission. If they find out that you really are having a heart problem, they then admit you to the hospital.

The problem is that recent changes in Medicare have changed payment for this. Medicare considers this unnecessary since you are NOT admitted and refuses to pay for it therefore leaving you with the bill.

So what does this mean? If they do a nuclear stress test, X-ray, blood work, (YOU GET THE IDEA) you get stuck with the entire bill and I am not talking the discounted one that the insurance companies pay, I mean the whole thing.

I talked with a physician in an 24 hour Observation Unit and asked if this was true and she responded yes. What they are doing is explaining the "No Pay" rule from Medicare and letting the patient make the choice to go home or stay and get stuck with the bill.

Patient's who refuse to stay are then listed as going AMA (against medical advice) which also triggers Medicare to refuse to pay the ER bill because you decided you knew better than the doctor.

Geese, I guess they just want us all to die or pay for our own medical issues even when we have insurance. Wonder who was responsible for this move?

Just thought some of you (those on Medicare) would like to know this so you don't get stuck with a $4,000 to $6,000 bill.

Lynne
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Old 04-22-2016, 08:26 PM   #2
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Your dreaming if you think $4000 to $6000!! I am Canadian and was across the border in Washington State and had an attack that was taken for a heart attack and I spent the night in the hospital and had cat scan nuclear scan stress test blood work etc etc. They contacted my travel ins. provider and they told me that if I did not stay my ins. provider would not pay. My wife confirmed it so I stayed.
The bill to date that my travel ins. covered was just under $24,000. Do not cross the border without insurance.
It turned out to be a gall bladder attack. Just had it hacked out last week so all is good again.
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Old 04-22-2016, 08:36 PM   #3
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My DW has liver cancer, we're on Medicare and she has COBRA. We're learning those "quirks" quickly!!
Also just today we got a letter saying that she's used up her long term disability payments so another $2,200 a month less to live on!
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Old 04-22-2016, 08:45 PM   #4
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Sort of the same for U.S. residents in that Medicare doesn't work outside our border. Whenever we visit Canada, we purchase short term medical insurance from AAA

Quote:
Originally Posted by slickest1 View Post
Your dreaming if you think $4000 to $6000!! I am Canadian and was across the border in Washington State and had an attack that was taken for a heart attack and I spent the night in the hospital and had cat scan nuclear scan stress test blood work etc etc. They contacted my travel ins. provider and they told me that if I did not stay my ins. provider would not pay. My wife confirmed it so I stayed.
The bill to date that my travel ins. covered was just under $24,000. Do not cross the border without insurance.
It turned out to be a gall bladder attack. Just had it hacked out last week so all is good again.
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Old 04-22-2016, 08:47 PM   #5
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FWIW there is also a large "it depends" clause. I had observation status paid for with a kidney stone emergency. One of several visitors was from the money side of admissions who laid out the differences in coverage depending on a lot of variables and the proper coding of the confinement. In short I paid my $50 co pay.
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Old 04-23-2016, 08:39 AM   #6
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A couple years ago I was in the ER and pretty much "scared" into staying only because the ER staff kept telling me that if I left AMA my insurance ( TFL, medicare & Tricare) would refuse to pay. I did leave/sign my self out AMA the next morning. ( my reasons aren't relevant here and as a former nurse understood the risk)
My insurance did pay. Later when complaining to the hospital about the behavior of the ER staff, the hospital patient advocate was horrified that the staff said these things to me. After researching, she told me that Medicare has no such non pay policy for AMA
Now you are correct about the admission verses observation policy.
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Old 04-23-2016, 11:12 AM   #7
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WOW! This is SCARY!
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Old 04-23-2016, 03:39 PM   #8
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This is correct. You can be admitted to the hospital for "observation" but that is how the hospital keeps track of you. However, "observation" is not a diagnosis, and "chest pain" is a symptom. You have to be admitted for a diagnosis like heart attack confirmed by lab test and Ekg. Know this from personal experience with TriCare as well as having my RN and working in a hospital. If they release you within 48 hours and nothing is wrong it is considered out patient emergency room visit. So, kind of scary huh? You are having chest pain and do you or don't you go to the ER.
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Old 04-23-2016, 04:31 PM   #9
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The only thing I can think of that is more confusing then Medicare are the tax code laws!
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Old 04-28-2016, 10:15 PM   #10
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Air ambulance from the Black Hills to Rochester Mayo, but discharged as "Under Observation". Medicare paid.
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Old 04-29-2016, 04:20 AM   #11
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Quote:
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Air ambulance from the Black Hills to Rochester Mayo, but discharged as "Under Observation". Medicare paid.
Maybe some confusion here. The debate is not that Medicare (or TriCare) will pay bills for "under observation" it is the rate (amount) they pay. It has to do with in or out patient charges.
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Old 04-30-2016, 04:33 AM   #12
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Quote:
Originally Posted by Tetonchief View Post
Maybe some confusion here. The debate is not that Medicare (or TriCare) will pay bills for "under observation" it is the rate (amount) they pay. It has to do with in or out patient charges.
As the OP said they did not know where this came from I can add that a similar story started a couple of years ago. There is a difference in how Medicare treats admitted and out patient services.

https://www.medicare.gov/Pubs/pdf/11435.pdf

The hospitals are aware of the issue and should be able to tell you what your particular coverage will probably be. In fact they are required to discuss the issue with you:

http://www.modernhealthcare.com/arti...NEWS/150809895

The major problem seems to be if one goes from a short stay to a skilled nursing facility.
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