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Admitted or Under Observation? Does it Matter?

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March 14, 2024 •  Emily Hicks Law, PLLC
Admitted or under observation? Learn what it means for your hospital bill.

In episode 28 of Elder Law Hour which aired on March 16th, Donna Lueders, Independent Insurance agent to Medicare eligible individuals, talks about the importance of asking questions during your hospital visit. It can be a stressful time when you or a loved one is having health issues and needs to go to the hospital.

One particular question that comes up is Am I admitted? Or am I under observation? It might not sound like a big deal, but according to the Medicare code, it could mean the difference between paying out of pocket or simply paying a deductible.

"Admitted” means the patient is in the hospital under the care of a physician, and “under observation” means the patient is staying in the hospital but as an outpatient. Even though they spend the night, no admissions papers have been signed making them NOT an admitted patient in the hospital. The hospital knows there is a difference for billing purposes, so they are required to let you know the status of your stay, but it's best to ask the question to make sure you are aware.

This cheat sheet talks about the differences in Part A which covers hospital stays and Part B which covers routine doctors visits.

If you have further questions, give Donna a call (904-669-1534). She can walk you through the tough world of Medicare coverage.

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