Kidney Disease
1,177 members591 posts

Hospital observation

The doc may not tell you ... in fact the doc may not even know !!! ... that if you go into the hospital for observation you may be charged out of pocket. Insurance may require you to be admitted.

Soooo you and your doc need to decide if your condition is bad enough for a hospital stay.

I heard this while volunteering at a hosoital a couple years ago and saw a reconfirmation in Aarp last year.

You may want to check all this out before you get an unexpected BIG bill !

15 Replies

I read the same thing. and have heard this from others who have experienced it. might give an explanation of observation status; and some pointers on filing a protest of the bill. There is also a web site on Medicare rights. Hospitals also might get more $ from observation status.


Also had another annoying experience the other day ... made appointment with a doc whose scheduler said that I ... ! ... will need to call medicare to sure that my yearly visit will be covered. My first visit was called an initial visit and she didnt know if that one would be considered a yearly visit and this new one would be covered since it was less than a year.

Also have had the lab tech ask me what kind of test i needed done. I asked if the doc hadnt said. I didnt know.

A nurse asked me what kind of visit I was there for.

By the time the nurse came back later with paperwork i had seen a sign giving me an answer to that question and i told her i dont do coding ... i was sorry i didnt have an answer ... NOT sorry tho ... irritated !

At least the doc is nice and is willing to talk to me and answer questions and refer me if necessary to specialists.

Guess im being cranky ??? :)


No, not being cranky, as one has to watch out on Medicare and what it will and will not pay for. There might be a year requirement on the annual wellness visit?


Yes there is. It was my thought that the scheduler should have that information and i shouldnt have to call medicare before every appointment.

Apparently some things ... like a mammogram ... you can have done during the same month as the year before but other things ... like yearly doc visits ... have to be a year and a day.


I was wrong ... annual wellness visits can be done every year and in the same month as the previous visit NOT a year and a day. Thats what the medicare agent i talked to said.

Other peopes may be different.


Don't forget about the deductible that you will have to pay before Medicare picks it up. I get surprised every year!


Not sure if this exactly what you are talking about, but I went to the ER last year in the middle of the night due to chest pains, a blood pressure that went from high to extremely low in a matter of minutes, arm and back pain and some other symptoms. They checked my stats which were only slightly elevated , had a doctor look at me and told me to go home, but before I could leave, another doctor told me to stay and they were going to keep me for observation. Then they decided to keep me overnight.

I was told if I leave that my insurance wouldn't pick any of it up. The insurance company ended up with a $16,000 bill and I had a $2,000 bill which I had to fight to get reduced as I felt I was trapped into staying. If I had been let go at the initial consult, it would have cost the insurance about $1,500 and me about $150.

Good news is they ran all kinds of tests on my heart which showed it to be quite healthy. Bad news iwas , of course, the bill, and the symptoms were also symptoms of shingles which they didn't catch and which erupted several weeks later.


You may have been admitted and the doc used the word observation. It all depends on how they send it to the insurance company.

I can only say what i was told by other volunteers at the hospital where i volunteered and what the aarp article said.

If you leave a hospital without a doc signing you off then thats against medical advice ... ama ... and insurance probably wont pay.

1 like

Ain't medical coverage great?!

On a somewhat related topic, the old vaccine for Shingles wasn't very effective. However, the new one, called Shingrix, is over 90% effective. I've already had the first one and the second is due in two and a half weeks, so I'll have that done when I'm traveling.


Thanks Mr K. Just looked it up as I was too young to have the old shingles virus covered, but looks like the new one is covered for 50 plus. Says it does affect immune system for several days so will need to discuss with my doctor since my type of kidney disease is very affected by my immune system.

1 like

I was informed by the pharmacist at Sam's last week about the newly formulated, more effective Shingles vaccine. It took the pharmacist about 15 minutes of research, but he found out that my Humana Medicare Advantage Insurance will NOT cover the vaccine for me -- even tho I have a chronic disease, am over 50 years old, and am required by my Nephrologist and transplant center to be current on all vaccines. The cost at Sam's for the 3-series, staggered shots is $160.

If you are curious about how Shingles became so prevalent in the past 20 years, research it in Google. The short version is that Merck convinced the FDA that kids needed to be vaccinated against chicken pox (even tho deaths resulting from childhood chicken pox in the US was very low). So, kids were required to get Merck's CP vaccine and did not get chicken pox. BEFORE the Merck CP vaccine, adults who had gotten chicken pox in their childhood and later were continually exposed to children or grandchildren who got chicken pox, they would get sort of a "booster" shot of the virus (and would, therefore, be less susceptible for getting Shingles). With very few cases of chicken pox since the Merck vaccine being given to children, adults were not getting the "booster" and the incidents of Shingles has increased exponentially.

To bring the story full circle, guess who developed the Zostavax (shingles) vaccine? Ding, ding, ding! You guessed it: Merck!

Big Pharma, the FDA and health insurance companies.....gotta love them!!

1 like

I understand ! I thought i got a shingles vaccine about 10 years ago but 2 years ago i went to the doc and said i had burning on my left side. My stomach hung over the area and i couldnt really see it well. I told the doc who said ... i told you !!! You have IBS... and kept doing whatever. Shes the one i left.

Two days later i had shingles from my belly button to my spine. The nurse practioner said ... o you poor thing ... and ordered an antibotic ?

I got another shingles shot this last january and have nerve pain once in awhile.


Not fun for sure. They did admit me under observation which is why I couldn't leave without having to pay a big bill.


I feel you Zazzel, but as an ex-paralegal working for Medical Malpractice lawyers, a lot of what hospitals do today is driven by fear of being sued for malpractice because they USED to let patients go home (with potentially serious symptoms) and the people died at home (having unfounded faith that "doctors obviously know what they are doing!" pifffffff). Therefore, in many cases, it is the hospital covering their butts as opposed to a financially-driven reason for "observation").

FYI: I continue to apply to my local hospital for financial assistance. Even tho I have Humana Medicare, if I were to be taken to the ER or admitted, the hospital will "zero-out" the difference between what Humana will not pay or the amt they adjust the costs of the hospital's services. I do qualify for financial assistance because I am now on SSDI as a result of ESRD. Most hospitals have a certain amount of "charitable giving" built into their budget in order to receive Federal funds. The financial assistance lasts for 6 months after approval.

I had two hip replacement surgeries at that hospital in the last two years (and, after falling at home after the 2nd hip replacement, was brought back to the hospital thru the ER and admitted to the hospital for 4 more days) and haven't had to pay anything to the hospital. [BTW: I fell b/c the hospital staff overlooked that I had "low sodium" or hyponatremia when they tested my blood before being discharged from the hospital. Hyponatremia will cause a person to be "spaced out" and not even know what was going on around them!]

Just saying......some of you out there that need financial assistance for hospital-related tests or other procedures may want to chk with your local hospital to see if they have a financial assistance program.


1 like

Makes sense about the insurance. Sorry to hear about you incidence with the hospital, but glad they covered it..

1 like

You may also like...