We naturally assume at least a portion of our medical care will be paid for by our insurance company. Policies detail what specifically is covered and which doctors, labs, pharmacies and hospitals are within your network. Health insurance is designed to cover doctor visits, specialists, testing, prescriptions, and hospital stays. However, seniors may be surprised to learn that their insurance company can actually reject an insurance claim for a hospital visit. Learn why below!
When you're seen at a hospital, a status is assigned to you. This status is very important for insurance purposes. If the doctor expects you to spend at least 2 midnights in the hospital, you are considered "admitted." Even if you spend 2 nights in a room, it isn't considered admission unless the clock hits midnight.
If you are there for less than 2 midnights, your status is considered "observational." Generally, doctors don't tell you your status, but will tell you if you ask. Your insurance company can bill you differently depending on the status you were assigned in the hospital.
When Status Matters
If you are admitted to the hospital but the insurance company feels your visit should have been observational, they can decline to pay the bill. Typically, this would occur if there's an error on the hospital's part, such as admitting you but discharging you sooner than expected. Although it's the hospital's mistake or doing, the insurance companies can use this as a loophole to avoid covering the visit.
An observational study results in a higher out-of-pocket expense for you. For example, if you have Medicare you'll likely be responsible for 20 percent of all tests and labs conducted.
Care After Discharge
Your insurance will not usually cover skilled care costs after discharge unless you spend at least 3 nights admitted in the hospital. If you are observed for a day, then admitted for 2 and discharged after, the insurance can decline coverage because observational care doesn't count towards the 3-day rule.
Many of the issues of aging can be solved by providing parents with the support they need to continue to maintain their independence. The resources provided by Caring Senior Service can help. Get in touch with us today!