Outpatient Observation Services

Frequently Asked Questions

What is outpatient observation?

Observation is an outpatient service that allows your doctor to monitor your condition to determine if you should be admitted to the hospital or allowed to return home. Although you may not require admission to the hospital, you may still require additional monitoring, diagnostic testing and medication before you're able to go home. When your condition is stabilized, you will be released.

What is a condition status?

We are required to assign a "status" to you when you are being treated or admitted to the hospital as an inpatient, outpatient or while under observation. We assign your status using guidelines that are required and used by hospitals and insurance companies, and we consider a number of factors such as the severity of your illness or condition and whether you can be treated and stabilized within 24 hours. This is important to you because the treatment you receive in an outpatient setting will affect the amount of your insurance co-pay or deductible.

If your status should change while you are staying with us, we will advise both you and your insurance company. This status change will result in a change in your co-pay or deductible.

What type of condition might I have that would require outpatient observation services?

If your symptoms are related to low iron in your blood, nausea, vomiting, pain in your chest, back or stomach; headache and some breathing problems, you may not have a serious or acute illness that requires an inpatient hospital stay. Your doctor may also place you in outpatient observation following a complication of an outpatient surgery or procedure such as abnormal postoperative bleeding, persistent nausea/vomiting, poor pain control or a fast heart beat.

What if I live alone and just want to stay at the hospital after my emergency room visit or outpatient surgery/procedure?

Most insurance will only pay if there is a medical condition for which you need to be monitored. Your doctor's order must support the medical necessity for the stay based on your illness or medical condition. If you desire to stay in the hospital for you or your family's convenience, you will be fully responsible for payment.

What happens at the end of 24 to 48 hours in observation?

Your doctor and nurses will carefully monitor your condition and will determine if you need to be admitted as an inpatient, or are well enough to go home.

What is the difference in billing?

Observation services are billed and covered under outpatient benefits provided by your insurance.

For Medicare patients, this is Part B coverage and therefore, outpatient deductibles, co-pays and co-insurance will apply. Inpatient admission is billed under inpatient services. For Medicare patients this is Part A. If you have coverage questions, please contact your insurance carrier.

Your status may affect the amount of your co-pay or deductible. Other providers who treat you during your hospital stay may charge you for the services they provide.

What is the difference in the quality of services and care I will receive in outpatient observation?

None. You will be cared for by your doctor and our qualified nursing staff. You will receive the same quality attention as any patient in the hospital.

I am a Medicare patient. Why am I billed for some of the medication I am given while receiving services at the hospital as an outpatient?

During the course of your outpatient treatment, you may be given medication that is considered self-administered by Medicare. Medicare defines self-administered drugs as medications that you could, in another setting, take yourself. The list of medications includes tablets, sprays, drops, inhalants and some injectable drugs.

In order to remain compliant with Medicare regulations related to the billing of these drugs, medical providers are required to submit these self-administered drugs as non-covered items on our billing to Medicare.

You will receive a bill from us following payment of our claim by Medicare. In addition to any deductible and coinsurance due, this bill will reflect the charges for unpaid self-administered drugs. Payments for non-covered items will be expected from you. With few exceptions, most secondary insurances do not cover self-administered drugs. For more information regarding self-administered drugs and what may be covered, refer to your "Medicare and You" handbook, or call Medicare at 800-633-4227.