David1961
Thinks s/he gets paid by the post
- Joined
- Jul 26, 2007
- Messages
- 1,085
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?