Insurance

What does it mean inpatient and outpatient? My in insurance pays more for outpatient than inpatient. Is there so many hours you can be at the hospital for it to count as a inpatient? I'm just worried because I live 2 hours away and if there is a slight problem they might keep me over night. Just not wanting to pay any extra than I have too but if I know it's gonna be worth every penny if I do. it's me over thinking again.

outpatient is when you're in and out in the same day. for example, I had a Laparoscopy to find my endometriosis as an outpatient. I was in and out in the same day.

inpatient is where they keep you there so they can watch you

Many insurance consider being in your room less than 24 hrs to be outpatient. They look at time in a room, not OR or recovery room, at least some insurance does it that way. Check with your insurance. They don't all do it the same way. You might be able to stay late or even until morning and still be outpatient but ask ahead to be sure how they view it.

For insurance purposes, outpatient means you were not formally admitted to the hospital. Usually, you can be observed for up to 23 hours in the hospital without being formally admitted. Within that time frame, you could even be kept overnight. However, each facility and insurance plan can have different criteria so if you have questions check with your insurance and your medical facility. Your doctor should also be able to tell you if s/he plans for your surgery be done on an outpatient basis.

In general, you are outpatient if your stay is less than 23 hours. For my last surgery (not my hysterectomy), my 23 hours did not start until I was placed in a room after leaving Recovery. An overnight stay was planned and I was in a private room during my stay. For others, the clock started as soon as surgery was over and included time in the Recovery room.

Also, double check as to whether for you it would be 23 or 24 hours. That can differ as well. For me, my insurance company, the hospital, and my surgeon all used a 23 hour cut off.

According to my insurance company, an "outpatient observation" is when you stay at the hospital for less than 24 hours. That 24 hours can include the hour of midnight (i.e. be overnight), but cannot extend past 24 hours at which point it would be considered "inpatient."

I am scheduled for a LAVH on Tuesday. A LAVH with an "inpatient" stay requires preauthorization with my insurance company. A LAVH with "outpatient observation" does not. But if something happens during my surgery that would require my stay to be extended (I guess if I were converted, or had anesthesia trouble, or whatever) then the surgeon/hospital has to call and explain why I am now being treated as an inpatient.

I had my last surgery date cancelled because the pre-authorization for an inpatient LAVH was denied. No word yet on whether it was approved this time, but the surgeon plans to proceed as a LAVH with an "outpatient observation." My OR time is 2pm, so this will include an overnight, so I guess I just can't stay for dinner the next day! ;-)

This is how MY insurance plan works, I'm sure they're all different. I had to talk to 10+ "member services" reps before I finally got this explained (hopefully correctly!) to me! Good luck!

and on another note similar to this topic... my disability pay through work says if you are outpatient.. you use 5 PTO (sick/vac) days before disability kicks in and if you are out of days as it is the end of the year, no pay! but if you over inpatient, disability pay starts next working day!

Thanks y'all for the info I will be calling my insurance tomorrow