Download Observation Outpatient Commonly Asked Questions

Top Observation Outpatient Commonly Asked
Questions and Answers
Welcome to Saint Joseph Mercy Health System. Based on your needs, medical condition and insurance
guidelines, your physician and healthcare team have determined you to be an Observation Outpatient.
This means we will continue to closely observe your medical condition as an outpatient for a period of time.
Then, your doctor will determine if you should be sent home or admitted as a hospital inpatient. Being
an Observation Outpatient does not impact the quality of care you receive. It is a billing designation.
While you are being cared for as an Observation Outpatient you may be placed in one of our inpatient
hospital rooms to enhance your comfort, however this will not change your observation status.
Below is a list of commonly asked questions about Observation Outpatient Care. If you have more questions
or need help completing the list at the end of this document, please ask anyone on your care team for
assistance.
1. What is the difference between Inpatient, Outpatient and Observation Outpatient?
INPATIENTS are formally admitted to the hospital for treatment of an illness or to undergo surgery.
OUTPATIENTS receive treatment or surgery at a hospital or health center, but are not formally admitted.
OBSERVATION Outpatients — two pathways:
Planned Outpatient Surgery — undergo surgery and require extended observation.
Emergency Visit — enter through emergency department and require ongoing tests and monitoring to
determine the cause of illness and plan of care. Once results are available, your physician will make
the determination to either admit you as an inpatient, or continue to observe you as an outpatient.
2. Why have I been designated an Observation Outpatient?
Based on your insurance guidelines related to your medical condition, your physician and health care
team designated you as an Observation Outpatient.
3. Will my insurance company cover an Observation Outpatient stay?
This depends on your insurance plan: Medicare Part A covers inpatient admission.
Medicare Part B covers outpatient services, including an Observation Outpatient stay. Keep in mind that
Medicare Part B typically requires patient to pay a 20% co-pay on each service you receive, after you
have met your Part B deductible. Medicare Advantage Plans, also known as Medicare Private health
plans, have different costs and rules. Contact your plan directly to learn about your benefits.
If you do not have a healthcare insurance policy in addition to Medicare, the hospital will send you a bill
for services that are not covered by Medicare.
For other primary healthcare insurance companies contact your plan directly to learn about covered
benefits.
4. How long can I expect to be in the hospital?
Typically, Observation Outpatients undergo testing and a plan of care is determined within twenty four
(24) hours.
5. What if my condition changes?
While you are an Observation Outpatient you will be closely monitored by our health care team. Should
your condition change, your physician will re-evaluate your status to determine if you will go home or be
admitted as an inpatient.
6. What things may not be covered?
Medicare Part B does not cover self-administered drugs – that is, any medications that you can give
yourself. However, as of January 2016, Medicare now allows hospitals to provide self-administered drugs
that are part of your treatment for any outpatient service, including observation stay, emergency room,
outpatient surgery – at no charge to you. These include any medications you’re currently taking at
home. Examples include any prescriptions or over-the-counter medications, insulin, or topical products.
7. Why should I use hospital medications instead of my own?
When you are given medications that the hospital supplies, all information about these medications
automatically populates your electronic medical record. This allows the computer to assess if you have
any interactions with other medications or treatments that you should avoid. Also, because each hospital
supplied medication is individually barcoded, it ensures the right medication is given at the right time. To
assure your safety and the effectiveness of the medication you take while here, it is always safer to take
the hospital medication.
8. Who can I appeal to about having an Outpatient Observation status?
You may request a second opinion. Ask to speak with your Case Manager or Social Worker. They will
arrange for a review by the Medical Director of Outcomes Management.
9. What if I can’t afford the co-payments?
You are not alone. Saint Joseph Mercy Health System Case Managers and Social Workers are available
to assist you. Financial counselors can help determine payment plans or your eligibility for other funding
sources. Customer Service representatives can assist you with prescription reimbursement questions.
Financial Counseling: Call 734-712-2009
| Customer Service: Call 734-712-3700
Who can I contact for more information about Observation Outpatient Care?
Medicare: Call 800-633-4227
Healthcare Insurance Plan: ___________________________________________________
Prescription Insurance Plan: ___________________________________________________
Long Term Insurance Plan: _____________________________________________________
Hospital Social Worker or Case Manager: _______________________________________
stjoeshealth.org
DiscoverRemarkable