How can a hospital refuse to admit, but hold "for observation" for 3 days while waiting to get into geriatric psych unit to adjust meds?

As I remember, it has been a couple of years, the hospital tried this. When I put my foot down (I had MPOA & DPOA), as mother was in "observation" and they started giving me the run around. As I do remember what I was told, they did not have the right to keep her in Observation when she needed to be evaluated for admittance. They kept it up, until they said they were releasing her - my pushing. When she needed to use the toilet and they brought her a commode and left it. I asked for them to help her - when I was told she could get out of bed to use the commode and I replied "No she can't, she is unable to get herself out of bed and I am not capable of helping her (bad back).

All of a sudden she had help. And when PT wanted to test her she was not able to walk 3 feet WITH a walker. Things changed in a hurry.

Get on the phone, call her doctors, insist on speaking with the attending physician. Don't take "NO" or "when they have a few minutes" for an answer. They are supposed to be helping her. Get whom ever holds the Medical POA involved along with the hospital patient Advocate (there should be one involved).

Good luck and God Bless,

I would refuse to have her taken to the hospital unless they will admit her as an inpatient! A psych hold in a case of aggressive behavior should be impatient!

This is something I wrote to help my family when a loved one is sent to the hospital. Most of the time the 3-day (midnights) applies to Traditional Medicare, many Advantage Plans waive this requirement.

Know Your Rights!

Observation vs Inpatient

When the doctor tells you that they are going to admit your loved one to the hospital you need to ask “Are they being admitted as an inpatient or Observation?” If the answer is inpatient there is nothing else you need to do. If your loved one is being admitted under “Observation” you need to be aware of some potential problems.

Observation Status is paid by Medicare Part B, while inpatient status is paid by Medicare Part A. Individuals who are enrolled in Medicare Part A, but not Part B will be responsible for paying the entire hospital bill if they are listed as “Observation” status.

Since March 2017, federal law has required hospitals to provide both oral and written notification to patients that they are being admitted as an Observation status if they are being admitted for more than 24 hours and are not being admitted as an inpatient. This is called the “Medicare Outpatient Observation Notice” or MOON, and notice must be given to the patient within 36 hours of admission to the hospital. 

·       When an individual’s status is “Observation” they may be charged for services that Medicare would normally pay for such a copayment for each outpatient service they receive or 20% of the Medicare-approved amount for most doctor services after Part B deductible.
 
·       In order to get Medicare to pay for rehab in a long-term care facility the individual must be listed as an inpatient for three (3) midnights. If your loved one’s status is “Observation” Medicare will NOT pay for their rehab; it will be an out-of-pocket expense.

What options do you have if your loved one is admitted under “Observation?”
1.     If the individual is still in the hospital:
a.     Ask the doctor to help change their status to inpatient.
b.    Use Medicare’s “two-midnight rule.” (Not to be confused with the (3) three-midnight rule above). This states that if their doctor expects the individual to require hospital care for at least two midnights, the hospital should be able to admit the individual as an inpatient.
c.     Consider other resources for care such as an inpatient rehabilitation hospital, home health care or, outpatient therapy. These do not require a three (3) day inpatient stay.

If the individual is no longer in the hospital: Medicare does not have an official method to appeal the Observation status at this time.

Note: This information applies to Traditional Medicare. Many of the Medicare Advantage Plans don’t require the “three midnights” to receive skilled care in a long-term care community. You need to check with your Advantage Plan to make sure you are covered in the event you are sent to the hospital.

TGinTN99: Your profile says that your mother has been moved. Prayers sent.

The hospital makes a lot more money holding a person for observation.

Yes insist on admission! I had to do this to avoid astronomical expense.

Call them doctor and Adult protective services for help. And do NOT no matter what is done or said take her home. Walk away if you need be. They will have to take her. Good luck.

good luck. my mother fell and had a convoluted break in her arm (91) was taken to the hospital but due to her having osteoporosis they knew that surgery would not work due to the pins/screws not being held into her bones, they kept her for 3 days under "observation" also........so medicare would not pay. i didn't understand why but i guess because no iv's, no oxygen, etc......just there until a room available in NH. Thank God my mother had the money to pay for the bills (after my dad's insurance took care of the majority of them)........but she still had to pay also privately for her rehab because she never took out Part B and she was not at a "certified rehab center".........but things went okay. You can set up a payment plan and they have to accept what she can afford. don't fret over it too much......there are alot of people without insurance and as long as you try to make payments, there is not much they can do. wishing you luck.

I literally JUST brought my DH home from a week long hospital stay. He was basically 'under observation' but I made SURE he was ADMITTED as per his PCP's instructions AND the ED doc. I don't need 7 days of a stay in the hospital along with every test known to medicine (which showed NOTHING) being our responsibility.

As it is we still will be out $5-6 K, easily, with reaching our out of pocket and the 20% co pay. Considering they sent him home just as sick as when he went in, that really rankles....I am grateful we have good insurance, but still.

Been there done that, where Mom was actually admitted due to here collapsing at the doctors office and going into shock (I forget the addition to hospital chart added when I told them what the doctors office diagnosis necessitating central line to revive Mom). Three days later the hospital (which hindsight is 20/20) they performed a C-diff test which came back positive (Mom was patient #5 on the unit...hence hindsight 20/20). Day 7 (day 3 treating for c-diff) I was told to pack her things she was going home as she was only under observation. I said No I and home caregivers were not qualified to treat and control c-diff a highly contagious disease. So I called Adult Protective Services and they agreed that it was a Health Safety Issue to bring Mom home. Hospital was furious.

I see on your profile that your mom has been moved. You said yesterday. Did you mean May 22, 2021 or was this a different time?

This observation hell is a huge problem when you are caught up in it. A MC should have been able to advise you on each step. This is surely not the first time they have been in this position. Although, what are the options? Hire a nurse to watch her at your home or a hotel room? MC won’t keep her. Hospital won’t admit her. Psych hospital won’t accent her. Where does she go?

One of the issues to me is that consumers aren’t given clear guidelines on what the choices are or what something is going to cost.
Was there another psych unit she could have been taken to? A different ER? Did she even need an ER since they sent her there for specific tests? Was moms choice of testing location based on being the nearest to the MC in order to access Medicare to pay for the ride? 3 weeks they were dealing with this but more importantly she was dealing with it. It seems when choosing a MC we are also choosing a hospital etc.

Why wasn’t the UTI tested for right away? The other tests could have been done outpatient. Does your mom act out with you? My DH aunt, with dementia, doesn’t with me but can be ugly to bathers. So while I might not want to do certain things with her, I know that I could take her for tests or ask the tests be done onsite when possible.

Lately with my DH Aunt, I just look at it as this is what she saved for. At almost 95 it’s ok to spend it if it’s needed. We can’t always know everything in advance but we do need to ask all the “what if” questions we can think.

In a setting such as your moms, I would be thinking surely they know what’s best but I’ve learned a few times, not the case. They know what is expedient for them. After all, they aren’t going to be paying the bill.

Hospitals are not transparent. They already know or highly suspect that insurance isn’t going to pay when they elect observation. I would like to better understand their checklist when a psych patient walks in the door. Perhaps psych hospitals should have their own ERs? Perhaps they do, but maybe your moms MC doesn’t have a contract with them? So hard to know all these things on the spot.

I’m sorry for all the losses you and your mom have recently suffered. I hope they get her meds straight and she can be at peace.

Sad situation. I’m so sorry that you are going through this. Unfortunately. these situations occur. It’s crazy.

This is not the way it is supposed to work. However, your mom needed to be "held" somewhere until a bed opened up for her. Ask the hospital and their social service department to help with with Medicare and other payment options.

When she went to the hospital, her Medicare and insurance info would have been shared with them. That's the first thing they want to know, payment. I doubt seriously they are holding her in observation knowing they would not get paid. Call the hospital and talk to a case manager to find out about the billing. I bet you'll find out that Medicare does cover this care.

I'd say take on the hospital and see if they won't change her status. Make sure you never sign as the responsible party on her admittance papers. Even if you get the hospital to change status to admitted - you may also take on Medicare to get them to pay if they feel it was observation only. However, considering the dx and that facility won't let mom back in until she in geriatric unit, in all reality it should be covered. Make an appointment with the Social Worker and see if he/she can be of assistance.

Im sure the Hospital will want her admitted asap because they want to get paid.

They probably just didn't have any room and couldn't just place her in a regular room due to her behavior.

You could check with the higher ups and tell them that there is no money and if they want to be paid they better turn it in to the Insurance Co Coded the right way to get paid.

If your mother doesn't have the money to pay the bill, then it doesn't get paid. Unless you signed a paper committing that you were financially responsible, you have no obligation (in most states) to pay your mother's debts.

Hospitals want to get paid. Simply remind then that Mom has no income. If they bill insurance (Medicare) improperly, Mom has no funds to pay.
They are not going to sue her, unless she has a bank account worth emptying. Does she?
If she does, pay the bill. If not, the hospital will code it properly.

My husband has been in Observation several times, and his stays were covered by Medicare. Medicare would not cover a rehab facility or post hospital medical unless he was "admitted" for several days (cannnot remember whether 3 or 5 days). You need to contact your local Medicare office. Hope all turns out well for you.

I had the same experience with my mother that one of the other posters did. You have to be admitted to be eligible for post discharge Medicare funded rehab but there is no reason why Medicare and your supplemental wouldn’t pay for a “medically necessary” period of observation when she is already in a nursing home. Call CMS and check. We found then very helpful.

Oh yeah! I think hospitals do that so it doesn’t mess with their statistics. My father had a stroke and was on "observation" for 10 days! My parents had to take out a second mortgage to pay the $12k bill.

I think she's referring to "observational" status as opposed to admitted status.   

"Remember, even if you stay overnight in a regular hospital bed, you might be an outpatient. Ask the doctor or hospital. You may get a Medicare Outpatient Observation Notice (MOON) that lets you know you’re an outpatient in a hospital or critical access hospital. You must get this notice if you're getting outpatient observation services for more than 24 hours.

The MOON will tell you why you’re an outpatient getting observation services, instead of an inpatient. It will also let you know how this may affect what you pay while in the hospital, and for care you get after leaving the hospital."

https://www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status

I was in that situation when I had an emergency appendectomy.   One of the ER physicians said I would have the operation and follow-up on an "observational status."  I stated that I must be admitted b/c otherwise I could not pay for anything not covered by Medicare, and not only that, I would refuse to pay b/c for surgery, I felt admittance was required.

The ER doctor was unaware of those distinctions and I was admitted.

Who told you that Medicare won't pay for observation?

My understanding is that they won't pay for post hospital rehabilitation if they are not admitted but, the hospital bill is covered.

I would verify that the information is correct with the billing office. I could have outdated information, it has been a couple of years since I had to deal with this situation.