Emergency Room Trip – Mom or Dad Under Observation or Admitted

ER Trip This blog post was updated on 3/8/2017:

After many complaints, thousands of dollars in medical bills and other issues that affect our most vulnerable populations (the elderly and the disabled), the law has changed. 

The Centers for Medicare and Medicaid has posted the new requirement that hospital personnel must inform Medicare beneficiaries of their status – Under Observation or Inpatient (written and oral notification called the NOTICE Act, effective 3/8/2017).                         

Read my blog post to find out why these few words are so important and may save you tens of thousands of dollars – Under Observation or Inpatient/Admitted. 

Here’s my blog post originally posted on 8/12/2014:  Just recently, I entered the emergency room of a local hospital with an elderly relative who was ill. Unfortunately, this happened a couple of times within a few weeks. Here is what I learned from those experiences:

ER VISIT #1

The initial visit this summer to the ER was fairly normal with the doctors, nurses and technicians trying to figure out what was ailing my loved one. After about four hours, the initial diagnosis was given by the ER doctor. An hour or so later, the hospital doctor came into the room and announced that my loved one would be ADMITTED.

That was good news to us, now the next phase of treatment could begin. We waited for a hospital bed to be readied as the night grew long and we were tired.

After a few days in the hospital, my loved one was discharged with some prescriptions and detailed instructions to follow-up with a primary care physician. This ER visit and hospital stay were nothing out of the ordinary. We were on the road to recovery, or so we thought.

ER VISIT #2

Things did not progress as we would have liked them to regarding the health of my loved one. So we had to return to the ER a few weeks later. More test, x-rays and blood samples were required. After the rush of activity in the room, the diagnosis was given. This was another 4-5 hour ER visit, but nothing seemed unusual. Until, the hospital doctor entered the room to let us know what the next step would be. He indicated that my loved one would be placed UNDER OBSERVATION in the hospital.

Upon hearing those words (under observation) my radar went up. I knew it could be a problem down the road if my loved one was placed under observation versus being admitted.

Once the doctor finished his spiel, I had lots of questions:

  • First, what does it take to have my loved one admitted?
  • Second, what is the difference between under observation and admitted?
  • Thirdly, can you change the status of my loved one to being admitted?

The doctor excused himself from the room and came back with a new status update. The hospital had reconsidered and my loved one was now being ADMITTED.

So who cares? Do you have parents or loved ones who have Medicare coverage? If a patient is under observation, Medicare may not cover related treatments and procedures after the patient leaves the hospital.

For example, mom falls and breaks her arm. She goes to the ER and is placed under observation in the hospital for a day or two. Her doctor tells her that she now needs rehab at a nursing home or rehabilitation facility for a few weeks. Little does she know, if she was under observation in the hospital those rehab expenses may not be covered by Medicare. The cost of rehab can range between $700 to $1,000 a day and up, depending on the treatment. Thus, a bill for tens of thousands of dollars could be mom’s responsibility.

Here is some information from www.medicare.gov:

The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for medically necessary hospital care.

An inpatient admission is generally appropriate when you’re expected to need 2 or more midnights of medically necessary hospital care, but your doctor must order such admission and the hospital must formally admit you in order for you to become an inpatient.

Remember, even if you stay overnight in a regular hospital bed, you might be an outpatient. Ask the doctor or hospital.

With our elderly population increasing, under observation versus admitted can be a costly few words for our most vulnerable population. In addition, increasing numbers of the baby boomer generation are now part of the Medicare program. Be careful and be aware on your next trip to the ER.

Aquanetta J. Betts is an attorney licensed in Washington, DC and Maryland – www.abettslaw.com. She helps individuals with wills, trusts and estates. Her work also focuses on charitable planned giving matters for nonprofit organizations. Connect with her on Twitter @Aquanettabetts

Disclaimer: Aquanetta J. Betts is not a medical professional nor does she claim to offer any medical advice in this post. This post is not intended to provide legal advice. It is for informational purposes only.

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