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I was hospitalized on December 31st after a surgery that was done that same day. Now it is looking like I'll be staying in the hospital at least another day or two for recovery into the new year.

I'm curious as to how the hospital stay will be applied to my deductible, because I had already met my out of pocket maximum and deductible for 2020, which resets January 1st.

When a hospital stay crosses into a new deductible period do they count the whole stay in the year you were admitted, the whole stay in the year you were discharged, or split it up across the years? The third option seems the most logical, but I doubt the hospital would submit a separate claim for each year for the same stay.

Any insurance insiders know what will happen in this situation?

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  • Some post-operative care gets bundled with procedures, but hospital stays usually come with per-day charges. You'll most likely have an early start on your 2021 deductible/max oop. It could very well depend on the procedure. I'm not a medical billing expert, I just know it's messy and inconsistent because I've worked on a couple dozen healthcare claims data analysis projects. For family planning this is an important consideration.
    – Hart CO
    Commented Jan 1, 2021 at 5:29
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    There are a variety of guidelines for inpatient and outpatient bill splitting and they vary from provider to provider for different private insurance companies and even Medicare. Hospital charges are billed for the day that they are incurred so you will most likely receive split billing.
    – Bob Baerker
    Commented Jan 1, 2021 at 14:31

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It depends on your insurance policy.

I just asked my wife who works in utilization management at a hospital. She deals mostly with Medicare and Medicare replacement plans, and in those cases it's based on admission date, even if it spans a new year, and even if it spans across different policies (the active policy on the admission date covers the entire hospital stay).

If you have a commercial policy it varies, and it depends on the insurance policy, so you'd have to check with them to confirm. I have heard stories of mother's having babies on New Years Eve and subsequently maxing out both year's deductibles. Hopefully this doesn't happen to you. Good luck.

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  • Wouldn't maxing out the deductible be a good thing? Or did you mean the maximum covered by the policy?
    – chepner
    Commented Jan 2, 2021 at 14:08
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    @chepner if you have no other treatment in the second year, it just means you pay 2 deductibles overall instead of 1.
    – Ganesh Sittampalam ♦
    Commented Jan 2, 2021 at 14:40
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    @GS-ApologisetoMonica Ah, OK, as opposed to the entire thing being billed against one year or the other.
    – chepner
    Commented Jan 2, 2021 at 18:18

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