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Despite long hospital stays, some patients never ‘admitted’, leaving them with huge bills

Harold and Sylvia Engler were shocked to find out that Harold had never been admitted to Beth Israel Deaconess while he was recovering from surgery. He had stayed for 10 days.
Harold and Sylvia Engler were shocked to find out that Harold had never been admitted to Beth Israel Deaconess while he was recovering from surgery. He had stayed for 10 days.Jonathan Wiggs/Globe Staff

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Thousands of Medicare enrollees in Massachusetts and across the country are finding themselves caught in a perplexing bind: Despite long hospital stays, they have been deemed observation patients or outpatients instead of “admitted” patients.

The difference in terminology is not a mere technicality: It leaves patients responsible for paying the full cost of follow-up rehabilitation care in a nursing home. They also can face higher costs for the hospital stay itself when they are not admitted.

These observation patients usually share rooms with so-called inpatients and receive care from the same doctors and nurses, making their status invisible to them.

Hospitals say it’s not their fault and that they are just trying to follow Medicare billing rules that even they don’t always fully understand.

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