How to know your medical status to save money

You're in a bed at the hospital and assume they've admitted you as inpatient, but are you really? You could be under observation - outpatient. Advice on getting clarity and saving money in the process:

Start with insurance. In addition to Medicare - including Part B which covers outpatient care - check with your employer or insurer about supplemental insurance and other coverage. If a hospital provider places you under observation, it will be easier on your pocketbook.

Know your status. If you're in the hospital more than a few hours and don't know if you're outpatient or inpatient, ask. Check also how this could affect out-of-pocket costs. Being informed won't change your status, but it could save you from a billing surprise later.

Appoint an emergency contact. Tell your family member, friend or caregiver that if you aren't in a position to ask the hospital about your admission status, they should.

Inquire about care decisions. Don't be afraid to ask about the pros, cons and necessity of tests and medications you're given. It's a good habit to be in anyway, and it could save you additional out-of-pocket costs if you're outpatient.

Appeal your admission status. If you're covered by Medicare and think you should have been an inpatient instead of outpatient, call 1-800-Medicare to make your case. A patient advocate may also be able to help you appeal this, and negotiate a lower bill with the hospital.


Comments

I had severe chest pain I assumed was GERD until the pain began to run up my chest into my neck. My Physician sister ordered me to get to the ER because I could be having a heart attack and immediately chew an aspirin. I waited in the ER for four hrs for a bed in the Cardiac Car Unit; then was admitted to a Cardiac unit upstairs for two days while a battery of tests was run. I have a private group BCBS policy through my former employer. When I got the bills, I was in shock. Everything was listed as O/P and I had a bill of $1200 in co-pays (I suppose it could have been worse...). When I challenged the status, I learned I didn't meet the 'Milliman Guidelines' for admission. Fortunately, it was not a heart problem (after two chemical cardiac stress tests); it was costochondritis-an inflammation of cartilage around my ribs. AT least Medicare requires you be informed of your status; there's no such protection for the rest of us.

Depend on the govt. like mr. thomas does you will find out what govt health care like England has will do for you , nothing

Robert Thomas your an idiot..... As a union worker I know how this mess got created...Democrats with a socialist agenda.

Elect a Republican! They will make sure the rich get great care and the rest of us die early.

I found out about this situation months ago and have been trying to send the alarm. It is actually MUCH worse than you can imagine. My DOCTOR told me I would have to go to the hospital for my gamma globulin infusion treatments (every 4 weeks). I checked in and got my wrist bracelet and got checked into my room. It was OVER a yr until I found out that I was considered an OUT-PATIENT. My gamma infusion costs a bit over $12,000 every 4 wks and the gamma was getting treated like a prescription drug with a 20% co-pay! ! ! Even though I had multiple health issues involved and the doctor said I HAD to be AT the hospital. The ONLY thing that saved me is there is a little known part of Medicare that says if your status is changed they HAVE to notify the patient. Since I verbally asked about the INPATIENT status each time, I used that rule to have the majority of the billing changed. BUT that was another HUGE fight with the hospital & Medicare was NO help.

Boy, did we have a surprise recently. My husband went into the hospital to have a pacemaker implanted. There was the chance that he might be kept overnight for "observation." We therefore "assumed" that it meant INpatient. We ended up with a $3,000 bill due to the fact that this procedure is considered out-patient by Medicare and therefore, Part A (which is strictly hospital stays) does not pay. Luckily, we have our Blue Cross policy that we have kept in force since retiring and it pays all but 20%. Another inequity with Medicare: I recently tried to make an appointment for counseling. Since I have my own private policy (FEP Blue....NOT a bridge), the provider said they couldn't accept me b/c Medicare is primary and they are not contracted to treat Medicare patients. Go figure. Providers have to PAY in order to take Medicare patients! What a travesty. No wonder this industry is confusing!! How can we sort this all out????

This is so true! My husband recently needed an angioplasty and subsequently a stent. He was kept overnight at the hospital but still was not considered an inpatient - only a "23 hour hold" type thing. We had to pay the $1700 co-pay UPFRONT when he was "admitted for the procedure" (but not as an inpatient). Being aware of fees like this ahead of time is important!

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