Under Observation vs. Hospital Admission – What You Need to Know

Under Observation vs. Admission

There are almost 2 million people each year that are stuck in "under observation".
Last year 617,702 people were in the situation with more than three days in the hospital ("under observation") and needed, but could not get Medicare to fund, rehabilitation.

"t is about the words that appear on hospital forms and small differences in the fine print that could mean thousands of dollars in payments down the line. we get details on this story tonight from our national correspondent, kate snow .

Reporter: 79-year-old m.j. is doing physical therapy after a bad spill in september. she spent three days in the hospital getting the same care as an in-patient but was not classified as one. instead, her chart said she was only under observation.

It was illlogical, i had a broken leg, it didn't make sense at all, what were they going to observe?

Reporter: and here is what she didn't understand, that label, under observation, technically made her an out-patient and that means that medicare won't care for her rehab in a nursing facility which costs $28,000.

The whole thing is outrageous and it is not right.

It is a huge problem, there are almost 2 million people every year who are stuck in this observation status alice in wonderland world.

Reporter: the number of patients in this status increased more than 6,000 since last year, and just this year, many more were like m.j.'s. patients in the hospital three days or more but not eligible for costly rehab coverage.

To the patients, our viewers, frankly it seems the hospitals share at least part of the blame for this.

Sure, they're in had the hospital , they will think all of this is a hospital decision. much of this is out of our hands.

Reporter: the representative for most of the hospitals in the country say they're being squeezed by medicare . in-patients cost more so medicare aggressively audits the classifiations given.

They edit the fact sometimes in years later, they take the payment back, unfortunately, the patient gets in the middle of this.

Reporter: we wanted to talk to medicare , but they denied our request on this, citing litigation on this very issue. the hospital that treated m.j. wouldn't discuss it with us, but said it is part of the rules when defining care. she and her husband who has parkinson's just moved in with their son in dallas to save money.

I worked my whole life. and I'm just appalled.

Reporter: now, any money they can save will go to her rehab. so far legislative proposals to fix this problem have gone nowhere. advocates say patients who end up in the hospital need to make sure they're admitted as patients, not just in-patients.

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Under Observation vs. Hospital Admission – What You Need to Know

6 thoughts on “Under Observation vs. Hospital Admission – What You Need to Know

    • Just showed this to my mom to explain why she is paying over $8000 a month for her skilled nursing care after she fell and broke her leg.

  1. This is another example of our government at work, taking a financially sound program that had a surplus of funds, stealing that surplus to pay other debts, and reducing the payouts to physicians to the point that they are now refusing to take Medicare patients.  Medicare patients who paid FICA taxes their entire working lives are left out in the cold.  This is a PONZI scheme of the worst kind, taking advantage of our seniors.  We need to replace Congress (along with the President) the next election. Duhhh!.

  2. All Medicare Supplement plans (Plan F, Plan G, etc.) are exactly the same.
    If you have been receiving rate increases, we can shop that plan for you to get the best deal. Call us at 1-800-729-9590.   SeniorSavingsNetwork (dot)  org
    Our services typically saves seniors from $50 to $150 per person, per MONTH.

    Let us shop for you! Thank you for watching our video.

  3. I knew about this when my 92 year old mother fell and broke her arm and chipped her hip. My mom could only walk with a walker before she fell, so with a broken arm she couldn’t even walk.  My husband, who is a physician, spent about 4 hours arguing and negotiating with the hospital in order to get my mom’s classification changed from Under Observation to Admitted.  My mom had to spend 6 weeks in a rehab center which she would have had to pay for herself.  Someone has got to change this unfair practice.  Medicare has to come clean and pay for medicare beneficiaries healthcare needs.

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