Question about Emergency Room policies

[Tippyboat]

I just wanted to make sure:

Especially in cases of life-threatening situations, the ER (or just hospital) is obligated to do whatever it takes to save the person without making sure they can pay right? As in, they're not allowed to hold out on treatment until they can verify payment?

So if the person doesn't have insurance and just can't pay the bills afterward, does the hospital just eventually drop the bill?

What's a good book I can read to get to know how the whole healthcare billing/obligations to treat system works?

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[migm]

I just wanted to make sure:

Especially in cases of life-threatening situations, the ER (or just hospital) is obligated to do whatever it takes to save the person without making sure they can pay right? As in, they're not allowed to hold out on treatment until they can verify payment?

So if the person doesn't have insurance and just can't pay the bills afterward, does the hospital just eventually drop the bill?

What's a good book I can read to get to know how the whole healthcare billing/obligations to treat system works?

Yes. EDs are the "de facto" universal health care, accepting all individuals for care -regardless- of ability to pay for treatment (if their treatment warrants it). If the individual cannot pay? The hospital picks up the tab.

Note that only hospitals receiving gub'mnt cash have to do this -- but this is almost all of them.

 

[Tippyboat]

What about, say, chemotherapy or life-saving surgeries?

 

[JackInTheBox]

What about, say, chemotherapy or life-saving surgeries?

I'm not a doctor, but I doubt chemotherapy would fall under the umbrella of emergent care.

 

[Tippyboat]

Yeah I know it doesn't fall under emergency care. Sorry I didn't explain, I'm branching the question out into a more broad sense:

in all life-threatening situation (involving things like chemo or important surgeries), do hospitals treat first and BILL you later (hoping you can pay), and ultimately pick up the tab if you cannot pay?

 

[migm]

I'm not a doctor, but I doubt chemotherapy would fall under the umbrella of emergent care.

The guideline for the law is whether delaying treatment for more than 24 hours would have a significant impact on the individual. Chemotherapy is not going to fall under this category, but surgery very well may.

If treatment is required given the condition and specific cirumstances, it must be given. Hospitals provide millions of dollars of this type of treatment every year. Emergency departments are *expensive*

 

[nontrdgsbuiucmd]

MIGMs take matches my understanding; I spent a few hundred hours in an ER and asked people about this as I was curious as well.

I was told that if the hospital accepts federal funds (medicare/medicaid) it must "accept all takers" regardless of ability to pay. And in my experience, no one asks the patient at any point if they can afford whatever tests are ordered; the MD/Nurse Practitioner/PA simply orders the tests and acts on the results. But that does not mean that the hospital will not try to pursue payment for services rendered; I've been late on a small lab bill (OK, 4 months late) and got the nasty "we'll refer this to a collection agency if you don't pay it" note. Hospitals must try to collect on this type of bill in order to protect their ability to care for all; if they didn't, they would not be acting as a responsible agent in a managerial sense.

But for the person who truly cannot pay, this will impact their credit score but ultimately most hospitals will just let it go. Hospitals do have a "charity" fund set aside to cover this type of thing, if I were unable to pay a bill I'd contact the patient advocacy office to see how to apply for charity funding to cover my care. This is partially a public relations issue, particularly given many hospitals are run as not-for-profit entities; it would look really bad for a person to lose their home due to an unpaid large medical bill incurred at a not-for-profit hospital.

I was told by an ER doc that technically and legally, the ER must only triage the situation (if the patient cannot pay), taking care of patient short term need; practically, I've not seen a person ever turned away, but from what this doc said, the hospital could refer a non-emergency case (and I've seen plenty) to another facility.

I'm sure there is a legal definition of "emergency" type conditions that legally must be covered; a patient I saw with advanced cancer (which the onc had said was terminal in a prior visit) would be admitted to the hospital regardless of insurance as she also had liquid filling her lungs and truly was in the final stages; I would doubt chemo or preventative care would fall within this umbrella.

For books to read, I'd go to a large library, check out the medical area (in my library near the MSAR) and see what looks relevant. Check the author's experience/professions; anything written by a politician or solely by a practicing physician will likely not address business/public health/budgetary issues that are key to understanding this.

 

[phospho]

The relevent law is known as EMTALA. It states that medical facilities are obligated to provide a medical screening examination and stabilization for anyone who comes to their facility, regardless of ability to pay.

However, hospitals are still allowed to bill for the services they provide, and they will try to collect. Some hospitals write-off the bill very quickly, others may be quite aggressive in attempting to collect (filing liens, turning it over to a collection agency, etc).

So let's say a bum walks into the ER, and needs really expensive emergency surgery to stabilize him/her. The hospital will still admit even if they know dam well they won't be getting any money at all from that patient?

Wouldn't it be smart for some broke people to just not get any health insurance and simply go to the ER for any medical concerns they may have?

Sorry if I sound ignorant - I guess I should read up on this stuff a bit more...

 

[Handyman73]

A friend of mine works in a neurosurgery unit, and has said it is fairly common for someone from another country to arrive, EMTALA their way into lifesaving brain surgery, and then skip the bill by returning home (often to Central America.) The facility accepts this as a fact of life and welcomes the opportunity to train neurosurgery residents...

By law (at least in my state) the ER has to physically evaluate you (that is, "triage" you) before they can even ask information regarding to payment collection.

 

[migm]

So let's say a bum walks into the ER, and needs really expensive emergency surgery to stabilize him/her. The hospital will still admit even if they know dam well they won't be getting any money at all from that patient?

Wouldn't it be smart for some broke people to just not get any health insurance and simply go to the ER for any medical concerns they may have?

Sorry if I sound ignorant - I guess I should read up on this stuff a bit more...

Rare, but yes. It happens. Would you rather have a hospital concerned about making money, or one that is concerned about saving or improving lives?

 

[phospho]

Rare, but yes. It happens. Would you rather have a hospital concerned about making money, or one that is concerned about saving or improving lives?

I'm definitely concerned about hospitals saving lives, but I would also like to see the system getting compensated fairly. You don't see lawyers getting forced to spend hours reviewing your case before you pay them. Yes, we will be doctors someday who will "save lives"; however, at the end of the day, it's a dam job that I would like to get paid for fairly.

 

[Druggernaut]

in all life-threatening situation (involving things like chemo or important surgeries), do hospitals treat first and BILL you later (hoping you can pay), and ultimately pick up the tab if you cannot pay?

They will also typically try to get you to pay something, even if it's not the full bill. I believe the hospital I work at will cut the bill 40-60% to try to recoup some of their losses, and they're willing to take that payment in small monthly payments until they've gotten their money.

As for the poor coming in without insurance (or just government funded Medicaid), it frequently happens, and becomes a financial strain on the hospital. The doctor could assess the patient and decide that there is no life threatening condition and discharge them without working up their complaint, but many won't do so since every now and then an apparently ridiculous complaint turns out to be something far more serious. Then they are open to a lawsuit from the family of the now deceased patient, and taking that risk frequently isn't worth the hour or two it would take to rule out serious medical conditions related to the patient's complaint.

 

[migm]

I'm definitely concerned about hospitals saving lives, but I would also like to see the system getting compensated fairly. You don't see lawyers getting forced to spend hours reviewing your case before you pay them. Yes, we will be doctors someday who will "save lives"; however, at the end of the day, it's a dam job that I would like to get paid for fairly.

I completely agree with you. EDs should not be the fallback healthcare for all. It's expensive, it doesn't work, it clogs the ER up with people who know they can get care (non-urgent visits) but cannot afford to get it elsewhere. Plus, if you wait until you're sick enough to need to go to the ED your quality of life is probably going to be impacted as a result.

EDs are not made for this, but that's what they're used for now. Welcome to America!

 

[kac714]

Read the book Sick by Jonathan Cohn. Its really disturbing.. An ER has to treat you, however, if you don't have insurance, they can, and in many cases will, go after you to get you to pay. The book outlines several cases of this happening. So basically, they'll save you but then try and get as much cash from you after the fact.

 

[tkim]

Read the book Sick by Jonathan Cohn. Its really disturbing.. An ER has to treat you, however, if you don't have insurance, they can, and in many cases will, go after you to get you to pay. The book outlines several cases of this happening. So basically, they'll save you but then try and get as much cash from you after the fact.

Why is this disturbing?

 

[kac714]

because there are so many people who are un or underinsured, and we're supposedly the wealthiest nation in the world.

 

[tkim]

because there are so many people who are un or underinsured, and we're supposedly the wealthiest nation in the world.

I read your post as it being disturbing that a hospital will try to make you pay for life-saving services provided even if you can't afford them.

 

[Flopotomist]

Rare, but yes. It happens. Would you rather have a hospital concerned about making money, or one that is concerned about saving or improving lives?

I would rather have a hospital that was open as opposed to one that was closed because it couldn't pay the wages of the staff. The responsibility for health care reform in this country does not lie on the shoulders of hospital CEOs, it lies with the people and our willingness to pay for what we consume and what we demand of our health care system.

 

[shaggybill]

Rare, but yes. It happens. Would you rather have a hospital concerned about making money, or one that is concerned about saving or improving lives?

It's not that rare. I work in the ER and people come in for this exact reason all the time. It's very annoying having them clog up the ER when people with real reasons for coming in should be getting those rooms instead.

 

[135892]

Read the book Sick by Jonathan Cohn. Its really disturbing.. An ER has to treat you, however, if you don't have insurance, they can, and in many cases will, go after you to get you to pay. The book outlines several cases of this happening. So basically, they'll save you but then try and get as much cash from you after the fact.

Are you saying that it is disturbing how some patients won't pay the hospital for the services that they received? I completely agree with you