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Patient-Friendly Measure Moves to State Senate, Pickett Says
4/25/2014
HARRISBURG – Patients who have been hospitalized would be better notified of their outpatient status under legislation that passed the state House on April 9, said Rep. Tina Pickett (R-Bradford/Sullivan/Susquehanna). This will allow patients to be more informed about whether their hospital stays are covered by insurance.

“Currently, patients who have visited a hospital emergency room, only to be transported to a room later, may not realize they haven’t been formally admitted and are considered to be outpatients on observation status,” Pickett said. “The distinction between being admitted to a hospital or being an outpatient on observation status is critical when it comes to insurance coverage. Many times, senior citizens especially may not be aware they were not admitted until insurance bills start arriving in the mail.

“Locally, my office was contacted by a gentleman whose wife’s hospital stay was not covered by Medicare because she was admitted under a code of observation,” Pickett explained. “He was forced to pay $2,500 out of pocket to have her moved and the couple also has to pay for two days of her hospital stay because the hospital could not change her diagnosis code until her discharge. This is the type of confusing red tape that frustrates many residents, especially senior citizens and those who do not have familiarity with health care billing and paperwork.”

House Bill 1907 seeks to address this issue by requiring patients to receive both verbal and written notice that they have not been formally admitted to the hospital once they have been moved from the emergency room into a hospital bed for 24 hours.

While hospitals say patients receive the same treatment regardless of their status, the distinction between an outpatient “observation” status and an inpatient admission carries major insurance coverage implications, particularly for Medicare recipients. For example, Medicare will cover skilled nursing or nursing home care for up to 100 days after a patient leaves the hospital, but only if the patient had a minimum three-day inpatient hospitalization.

Consequently, if a patient is in the hospital for four days, but two of those are designated as “observation,” the patient could face thousands of dollars in added costs and, in some cases, be denied a bed if unable to make an upfront deposit.

The legislation now moves to the Senate for consideration.

Representative Tina Pickett
110th District
Pennsylvania House of Representatives

Media Contact: Jennifer Keaton
(717) 705-2094
jkeaton@pahousegop.com  
RepPickett.com / Facebook.com/RepPickett
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