What happens if you go to the emergency room without insurance?
If you do go to the emergency room without coverage, don’t worry. The hospital is required to treat you regardless of insurance status. Under the Emergency Medical Treatment and Labor Act (EMTALA), anyone who goes to the ER must be stabilized and treated, even if they are uninsured and it’s not clear how they will pay for treatment.
How does the emergency medical treatment and Labor Act Protect Me?
As you can see, the Emergency Medical Treatment and Labor Act protects your right to receive emergency care regardless of your ability to pay. If you're concerned about how you were screened or treated at a hospital emergency room, you should seek the advice of an experienced health care law attorney.
Does health insurance pay for emergency room visits?
What your health insurance company considers an emergency. Under the health care reform law (Patient Protection and Affordable Care Act), insurance companies are required to pay for emergency room care if a "prudent layperson, acting reasonably," would have considered the situation a medical emergency.
How long is Medicaid coverage for the treatment of an emergency?
How long is Medicaid coverage for the treatment of an emergency medical condition? The initial authorization period for the treatment of an emergency medical condition may be up to a maximum of 15 months: three months retroactive coverage from the application date and 12 months prospective coverage from the application date.
What Is Medicaid For The Treatment of An Emergency Medical condition?
Medicaid payment is provided for care and services necessary for the treatment of an emergency medical condition, to otherwise eligible temporary n...
Who Can Receive Medicaid For The Treatment of An Emergency Medical condition?
An individual is here illegally or is undocumented if s/he entered the United States in a manner or in a place so as to avoid inspection, or was ad...
What Is An Emergency Medical condition?
The term "Emergency Medical Condition" is defined as a medical condition (including emergency labor and delivery) that manifests itself by acute sy...
What Services Do Not Meet The Definition of An Emergency Medical condition?
Certain types of care provided to chronically ill persons are beyond the intent of the federal and State laws and are not considered "emergency ser...
How Long Is Medicaid Coverage For The Treatment of An Emergency Medical condition?
The initial Authorization Period for the treatment of an emergency medical condition may be up to a maximum of 15 months: three months retroactive...
What happens if you don't have health insurance in the emergency room?
If you're in the emergency room, you’re probably too injured to haggle with hospital administrators about how you’re going to pay for your care -- especially if you don’t have health insurance.
What is an emergency medical condition?
With respect to a pregnant woman who is having contractions, an emergency medical condition exists when: There is inadequate time to make a safe transfer to another hospital before delivery. A transfer might pose a threat to the health or safety of the woman or the unborn child.
What is the federal patient dumping law?
In a nutshell, the federal patient-dumping law entitles you to three things: A hospital must provide "stabilizing care" for a patient with an emergency medical condition. The hospital must screen for the emergency and provide the care without inquiring about your ability to pay.
Why was the patient dumping law passed?
The patient-dumping law was passed to ensure people in distress get necessary medical attention. If you have health insurance coverage, the ultimate question of payment is between you and your insurance company. If you don't have health insurance, you will still be asked to make payment arrangements with the hospital.
What to do if you feel unfairly treated by your insurance company?
If you feel you have been treated unfairly, either by the hospital or by your insurance company, call your state's department of health.
What are the penalties for EMTALA?
Those penalties may include: Termination of Medicare agreement. Fines up to $50,000 for each violation.
Is an emergency room required to treat you?
What you're not entitled to. If you're not experiencing an emergency, and you don't have medical insurance or the ability to pay, the hospital emergency room is not legally required to treat you. The hospital will most likely direct you to your own doctor or a community health clinic.
How long is the authorization period for a medical emergency?
Authorization Period. The initial authorization period for the treatment of an emergency medical condition may be up to a maximum of 15 months: three months retroactive coverage from the application date and 12 months prospective coverage from the application date.
What is Medicaid for emergency medical?
What is Medicaid for the treatment of an emergency medical condition? Medicaid payment is provided for care and services necessary for the treatment of an emergency medical condition, to certain temporary non-immigrants (e.g., certain foreign students, visitors/tourists) who are otherwise eligible and undocumented non-citizens.
What is a temporary non-immigrant?
Temporary Non-Immigrant. Non-immigrants are lawfully admitted to the U.S. temporarily for a specific purpose and for a specified period of time. Otherwise eligible non-immigrants, who are not New York State residents and who require immediate medical care may receive Medicaid coverage for the treatment of an emergency medical condition. ...
Is a new medicaid application required for an emergency?
Although a new Medicaid application is not required for later emergencies occurring within the established 12- month authorization, the Medicaid claim must indicate that it is for an emergency. The treating physician will determine if the medical conditions meet the definition of an emergency medical condition.
Does Medicaid cover rehabilitation services?
Rehabilitation services (including physical, speech and occupational therapies). The above-mentioned services do not fall within the definition of an emergency medical condition. Therefore, Medicaid does not cover the cost for the above-mentioned services or transportation to these services.
Is organ transplant covered by Medicaid?
This definition must be met, after sudden onset of the medical condition, at the time the medical service is provided, or it will not be considered an emergency medical condition and therefore, cannot be covered by Medicaid.
Is chronically ill care considered emergency care?
Certain types of care provided to chronically ill persons are beyond the intent of the federal and State laws and are not considered "emergency services" for the purpose of payment by Medicaid. Such care includes: Alternate level of care in a hospital;
Why would someone not have health insurance?
There are many reasons why people don’t have health insurance. To name a few:
Who pays for uninsured patient treatment?
Financial assistance programs are available to cover uninsured patient treatment, assuming the patient meets certain qualifications. Many Americans are enrolled in government-sponsored insurance programs like Medicare or Medicaid. There are also plenty of other public and privately held financial assistance options.
Improving the patient and financial counselor relationship
Patients often dread working with financial counselors, but this distrust is misguided. While doctors and nurses assess your physical health and provide medical solutions, financial counselors assess your financial condition and determine the best way to provide monetary assistance.
Getting uninsured patient coverage requires the right technology
Ideally, hospitals should both invest in a technology solution and use it to integrate the financial assistance screening into the emergency department’s registration process.
Causes
- If you're in the emergency room, youre probably too injured to haggle with hospital administrators about how youre going to pay for your care -- especially if you dont have health insurance. Fortunately, in 1986, Congress passed the Emergency Treatment and Labor Act (EMTALA) that prohibits a practice commonly known as \"patient dumping.\" The act gives individuals the right …
Scope
- The federal law applies to hospitals that participate in Medicare -- and that's most hospitals in the United States. Even so, EMTALA does not apply to hospital outpatient clinics that are not equipped to handle medical emergencies. But they are required to refer patients to an emergency department in close proximity.
Purpose
- In a nutshell, the federal patient-dumping law entitles you to three things: screening, emergency care and appropriate transfers. A hospital must provide \"stabilizing care\" for a patient with an emergency medical condition. The hospital must screen for the emergency and provide the care without inquiring about your ability to pay.
Criticism
- Public Citizen, a consumer watchdog group, claims that despite the law some hospitals continue refusing to provide basic treatment for patients who are unable to pay. \"Its distressing that this law has been in place and hospitals are still flouting it,\" says Dr. Sidney Wolfe, director of Public Citizens Health Research Group. \"The government needs to do more to force hospitals to comp…
Society and culture
- From 2002 to 2015, the Centers for Medicare and Medicaid found 2,436 violations, working out to an average of 174 violations a year.
Functions
- The Office of Inspector General (OIG) has the authority to issue penalties under EMTALA. Those penalties may include:
Facts
- The largest fine of $100,000, according to the OIG, was issued to Kaiser Foundation Hospitals in Santa Clara, California. The hospital agreed to pay $100,000 for allegedly violating the Patient Anti-Dumping Statute twice. According to OIG, Kaiser failed to provide appropriate medical screening examinations and stabilizing treatment for a 15-year old child that arrived at the emer…
Example
- In the second instance, a 12-year old boy returned to the emergency room after being sent home the night before. He was in pain, had a high fever and was lethargic with swollen eyes and face, but was discharged to the pediatric physician group on the hospital's campus. More than six hours after he went to the emergency department, he was admitted to Kaiser's Pediatric Intensiv…
Diagnosis
- If you feel you have been treated unfairly, either by the hospital or by your insurance company, try calling your state's department of health. If you feel your insurance company is unjustly denying payment, try your state's insurance department.
Background
- Under the health care reform law (Patient Protection and Affordable Care Act), insurance companies are required to pay for emergency room care if a \"prudent layperson, acting reasonably,\" would have considered the situation a medical emergency. In the past, this was only the case in some states. According to the National Association of Insurance Commissioners (N…