Observation status: What you want to know
FRANKLIN COUNTY, Pa. (March 25, 2014) – According to officials at Summit Health’s hospitals – Chambersburg Hospital and Waynesboro Hospital – many Medicare patients are concerned about their hospital status and what that means for their out-of-pocket cost.
“It’s important to get the care you need, but we understand that the cost of that care is a concern,” said Sherri Stahl, senior vice president of hospital services for Summit Health.
“Many people are under the impression that if you are on ‘observation’ status, the services you receive at our hospitals will not be paid for at all by Medicare. But, that is not the case.”
Stahl answered some frequently asked questions about “observation” status to help us understand, and know the importance of asking about our hospital status.
Q: What is observation status?
Stahl: Observation care is provided to patients who are not well enough to go home, but not sick enough to be admitted. You may be in a bed on one of our “inpatient” floors, but you are not considered “inpatient” status. Observation is considered an “outpatient” service, even though you may be inside the hospital for several days.
Q: Who determines if I’m sick enough to be an “inpatient”?
Stahl: Your doctor will provide the care that you need. The determination of “inpatient” vs. “observation” is made by specific guidelines from the federal agency that oversees Medicare. Your doctor will use those guidelines to determine your hospital status. The guidelines are based on the severity of the illness and the types of services required. The amount of time you spend in the hospital does not determine your status. However, this is being discussed by the federal government.
Q: Does “observation” mean my insurance won’t cover any part of my hospital experience?
Stahl: No. Observation status is considered an “outpatient” status. This would be covered under the outpatient benefits in your insurance plan. If you have questions about your personal coverage, I encourage you to talk directly to your insurance company.
Q: What if I have questions about my hospital status?
Stahl: We have a hardworking team prepared to answer your questions. For more information about your hospital status, please call:
- Waynesboro Hospital – (717) 765-3406
- Chambersburg Hospital – (717) 267-7129 or (717) 267-7169
Summit Health is a non-profit network of hospitals and physician practices dedicated to building a healthier community.
As Franklin County's leading healthcare provider, Summit Health offers family care, specialists, lab and imaging services, a fitness center, two walk-in care centers, and two award-winning hospitals.