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Inpatient versus outpatient
03-15-2014, 12:36 PM
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#1
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Thinks s/he gets paid by the post
Join Date: Jul 2007
Posts: 1,085
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Inpatient versus outpatient
I recently had a surgery planned at a hospital as an outpatient service, but because the surgery was a little more involved, I was admitted and stayed overnight. My insurance requires pre-certification for hospital admission but since I did not know I'd be admitted, the pre-certification could not have been done ahead of time. Is something like this considered outpatient or inpatient when it is submitted to the insurance company? I have done some research and the criteria seems to be if you were in the hospital at least 24 hours, it is considered inpatient. I was actually there about 28 hours so seems like it should be inpatient. This same experience happened about 4 years ago and it was treated as an inpatient. Have the rules changed or became fuzzy the past 4 years?
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03-15-2014, 12:46 PM
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#2
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Mar 2013
Location: Limerick
Posts: 5,633
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It should be considered an emergency admittance which shouldn't require pre-certification. Not everything can be planned.
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03-15-2014, 01:11 PM
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#3
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Nov 2010
Location: Sarasota, FL & Vermont
Posts: 36,204
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Quote:
Originally Posted by Dash man
It should be considered an emergency admittance which shouldn't require pre-certification. Not everything can be planned.
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Sounds right to me. Your doc/providers should be able to work it out with your insurer.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
Retired Jan 2012 at age 56
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03-15-2014, 02:52 PM
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#4
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: May 2005
Posts: 17,194
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Quote:
Originally Posted by Dash man
It should be considered an emergency admittance which shouldn't require pre-certification. Not everything can be planned.
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How can something that was planned be considered an emergency
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03-15-2014, 02:57 PM
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#5
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Mar 2013
Location: Limerick
Posts: 5,633
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The overnight admission wasn't planned. Something happened during the procedure to change the mind of the doctor about sending him home, preferring to have him monitored in the hospital overnight.
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03-15-2014, 03:46 PM
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#6
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Thinks s/he gets paid by the post
Join Date: Mar 2009
Posts: 2,975
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Complications. Evidently you have not had much experience with medical problems, like me. However shocking it may be, sometimes things don't go as planned.
__________________
Took SS at 62 and hope I live long enough to regret the decision.
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03-15-2014, 04:56 PM
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#7
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: May 2005
Posts: 17,194
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Quote:
Originally Posted by Dash man
The overnight admission wasn't planned. Something happened during the procedure to change the mind of the doctor about sending him home, preferring to have him monitored in the hospital overnight.
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OK.... misread the post... thought they admitted him before the surgery.... my bad..
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03-16-2014, 12:13 PM
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#8
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Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Join Date: Apr 2013
Posts: 11,078
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Quote:
Originally Posted by pb4uski
Sounds right to me. Your doc/providers should be able to work it out with your insurer.
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I would notify the insurance company myself. Agree the DRs and other providers will provide the documentation.
I only add this as one horrible policly I had many years ago had a provision that the patient had to inform them. I never did get them to answer the obvious question; what if I'm incapable of calling you?
MRG
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