Wellcare Dual Liberty (HMO D-SNP) (001): Outpatient Hospital Observation
Observation is typically 23 hours and initiated to determine whether the patient needs admitted to the hospital (inpatient) or can be discharged.
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Observation services are hospital outpatient services, provided to determine if there is a need to be admitted as an inpatient or if it is safe to discharge. Note that outpatient hospital observation can take place in a unit, inside a hospital, and even last overnight. Your loved one may spend observation time in the hospital, though that does not mean they are admitted to the hospital.
For outpatient hospital observation services to be covered, they must meet the criteria and be considered reasonable and necessary. Observation services are covered only when ordered by a provider. Reasons for observation might include (but are not limited to) persistent chest pain, fainting or loss of consciousness, head trauma, infection, or unresolved gut pain.
Unless the provider has written an order for inpatient admission to the hospital, the episode is considered outpatient, and cost-sharing amounts for outpatient hospital services apply. Even if there is an overnight hospital stay, it may still be considered outpatient. If outpatient versus inpatient status isn’t clear, ask the hospital staff.
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