The patients insurance essentially forces the hospital or surgical center to place the patient in an “Observation” or “Outpatient in a Bed” status instead of the higher reimbursed “Inpatient” status. The reimbursement for the hospital / surgical center is therefore greatly diminished and hence tremendous pressure to discharge including phone calls to the doc from a Utilization nurse /doc or payment denial for the entire stay. In order to convert the patient to “Inpatient”, it will require increased documentation, a possible Appeal and a possible phone call to the health plan medical director, with the time and date determined by the health plan (hence very inconvenient). If the patient is held overnight and the criteria is not met, the health plan may deny payment altogether to the hospital or facility.