A growing issue with patient classifications for those staying overnight in hospitals is driving some controversy around how government entitlement programs pay for care. While we’ve seen these kinds of issues crop up over the years, there are some new trends that are alarming to many consumers, especially those who rely on Medicare.
Observation Versus Inpatient Status
When patients come to a hospital or care facility, staffers have the responsibility to categorize them as either inpatient or under ‘observation.’ While there seems to be some leeway involved, government officials and others are pressuring facilities to practice consistency and transparency when classifying patients, because the difference between observation and inpatient care creates huge inequalities in patient financial responsibility.
Medicare Rules
Hospitals argue that Medicare keeps them careful about admitting patients on an inpatient basis, because of the kinds of charges that accompany inpatient care. However, patients are complaining that observation care is often not covered by Medicare. In response, consumer advocacy groups are considering lawsuits against the government entitlement program for its handling of observation situations, especially when patients stay in a facility for a long time, receiving the many separate care bills that go along with an observation status, without getting correctly processed as inpatient.
Problems with Insurers
Whether an insurer pays for additional observation care may depend on admission dates and patient status. When these issues get cloudy, and the information provided is not cut and dried, denials may surface. Patients can also find it harder to navigate claims payment when it’s not clear whether they were in the hospital under observation or under inpatient status.
In many cases, patients can eventually straighten the mess out and resubmit the claims to their insurer under the correct status. Still, there are many other cases where patients either don’t have the right advocacy or the resources to challenge insurer denials, or where significant clerical errors cause major problems in resolving a billing situation. The flurry of bills associated with care for patients under observation can make the whole process even more challenging.
Third party consumer advocates continue to look for ways to help American families deal with the many serious issues involved in sorting out high-dollar medical bills. When it comes to staying out of medical bankruptcy, anyone who has received major medical care can find themselves in very complicated situations, where they need help to decipher bills and figure out the best ways to resolve them. We will continue to bring consumers the latest and best advice for ironing out all sorts of situations with medical bills, including clerical errors, as well as differences in care classification that can lead to a merry-go-round of denials and collection attempts by providers and insurers, trapping patients in the middle. It’s important to get educated about the way that today’s medical industry works in order to keep your family out of debt and make sure that you get what you deserve out of a care situation.