How Can I Avoid ER “Observation?”

daughter hugging her fatherThis is a question Laura asked me this week. The answer is “talk to the ER doctor.”  

Laura explained to me that her dad wasn’t feeling well last month so she took him to the ER. The hospital held Laura’s Dad in the ER for several days. The room Laura’s Dad was in looked like a normal hospital room and she thought he was admitted to the hospital. However, as it turns out, he was actually in “observation.”

Observation means the physician is trying to decide whether the patient needs to be admitted to the hospital or can go home. The only way to know whether Laura’s dad was “admitted” or in “observation” was to ask. The hospital is not required to tell the patient that they are in observation. Medicare recommends that “observation” be limited to 24-48 hours, however, some hospitals keep patients in “observation” for much longer.

Laura and her dad found out why “observation” can be a problem. Laura’s Dad was referred to a rehabilitation facility upon leaving the ER. For many services like inpatient rehabilitation, you must have been admitted to the hospital for a certain period of time for your insurance to cover the service. Many insurance plans only cover rehabilitation facilities after a certain amount of time as an inpatient in the hospital. For example, you might need to be in the hospital for 3 days prior to being admitted to an inpatient rehabilitation facility for your insurance to cover the rehabilitation costs. If you were in “observation” for 3 days, that will not meet the requirements by your insurance company.

How do you avoid this problem?

  1. Talk to your doctor and ask whether you are admitted or in observation.
  2. If you think you must go from the ER to another care facility, ask the hospital whether it is necessary to be admitted into the hospital to get coverage.
  3. If you find out you are in observation, insist on being admitted if it is necessary to stay in the hospital.

Have you ever been placed in “observation” in the ER? How long did it last? I’d love to hear from you!

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