Caveat: E.R. Treatment Not Always Free for the Uninsured
By Barbara Perone
In the United States, any hospital that accepts Medicare must honor a 1986 law, passed by Congress at the behest of then-President Ronald Reagan, to allow the uninsured free emergency medical care if they need it.
But, the operative word here is emergency.
Participating hospitals place stringent limitations on what they consider to be a real emergency. So, if you are uninsured, be forewarned that just because you are ill and wind up in the Emergency Room (E.R.) that doesn’t mean the hospital won’t charge you for the cost of your visit.
The Emergency Medical Treatment and Active Labor Act (EMTALA) is actually part of the Consolidated Omnibus Budget Reconciliation Act (COBRA), the 18-month health care plan offered to most unemployed workers shortly after they are laid off from their jobs, according to the description of EMTALA given at the Wikipedia website.
Under EMTALA, hospitals must provide medical care to anyone who requires emergency healthcare treatment, whether the person is insured or underinsured, regardless of the individual’s citizenship, or legal status, according to Wikipedia.
In addition, participating hospitals may only transfer, or discharge, a patient who needs emergency treatment:
- under the patient’s own informed consent, and
- after the patient has been stabilized, or
- when the patient’s condition requires transfer to another hospital better equipped to administer treatment.
Patient dumping necessitated the law. Prior to 1986, many private hospitals treated uninsured (or underinsured) patients like “hot potatoes” by either refusing to treat them or opting to transfer them to public hospitals, based on the hospital’s anticipated high cost to diagnose and treat these kinds of patients.
Hospitals determine whether it’s a real medical emergency
Every hospital/trauma center/E.R. uses its own screening criteria to determine whether a patient is having a true medical emergency. If a hospital deems a patient in not having a true medical, emergency it can refuse to have the bill paid via EMTALA, according to Wikipedia.
Medical professionals categorize certain health conditions as non-emergent; they include, but are not limited to:
- normal delivery of a baby
- withdrawal from any opiate-like substance
- fever, elevated white blood cell count, and a possible abscess, or
- If a patient is already in the hospital for another reason, and then develops an emergency condition, EMTALA does not apply.
Here’s another little known fact – the federal government does not directly cover the cost of emergency care required by the EMTALA, according to Wikipedia.
That’s why uncompensated care, also known as non-reimbursed amounts, represents six percent of total costs to a hospital. These costs wind up becoming tax write offs (bad debt) for the hospitals, which they then sell to third party collection agencies for an average of 20 cents per dollar, according to Wikipedia.
For further details about the EMTALA visit www.ncbi.him.nih.gov/pmc/articles/PMC1305897.