Must Emergency Rooms treat uninsured destitute patients?

If so, how long?

Emergency Medical Treatment & Labor Act (EMTALA)

In 1986, Congress enacted the to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide:

a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay.

Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.  Wikipedia *   CMS.gov

Definitions

emergency department as “a specially equipped and staffed area of the hospital used a significant portion of the time for initial evaluation and treatment of outpatients for emergency medical conditions .”[9] This means, for example, that outpatient clinics not equipped to handle medical emergencies are not obligated under EMTALA and can simply refer patients to a nearby emergency department for care.[9]

An emergency medical condition (EMC) is defined as “a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual’s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.” For example, a pregnant woman with an emergency condition must be treated until delivery is complete unless a transfer under the statute is appropriate.[9]

Patients treated under EMTALA may not be able to pay or have insurance –

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or other programs like Medi-Cal pay for the associated costs but are legally responsible for any costs incurred as a result of their care under civil law.

A patient is defined as “stable,” therefore ending a hospital’s EMTALA obligations, if:

  • The patient is conscious, alert, and oriented.
  • The cause of all symptoms reported by the patient or representative, and all potentially life-threatening, limb-threatening, or organ-threatening symptoms discovered by hospital staff, has been ascertained to the best of the hospital’s ability.
  • Any conditions that are immediately life-threatening, limb-threatening, or organ-threatening have been treated to the best of the hospital’s ability to ensure the patient does not need further inpatient care.
  • The patient is able to care for himself or herself, with or without special equipment, which if needed, must be provided. The required abilities are:
    • Breathing
    • Feeding
    • Mobility
    • Dressing
    • Personal hygiene
    • Toileting
    • Medicating
    • Communication
    • Another competent person is available and able to meet the patient’s needs following discharge.   Wikipedia

The “prudent layperson” definition of an emergency medical condition is any medical or behavioral condition of recent onset and severity, not limited to severe pain, that would lead a typical person possessing an average knowledge of medicine and health to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could jeopardize life, limb, or mental health. The presenting sign or symptom is paramount, not the final diagnosis, when determining whether to pay emergency medical claims.  RAC Monitor Hospitals must screen patients who come to the ER *

Problems with this definition and how expenses health care inflation have increased  CMS.gov 100 – 07 Emergency Cases   *  acepnow.com/prudent-layperson-standard-emergency-medicine-attack/  *

Links & Resources

 

Medi-Cal Eligibility – Coverage  can be backdated 3 months!

Estate Recovery?

Wikipedia

 CMS.gov

Consumer’s Guide to coping with Medical Debt

Medical Repatriation – Deportation

 

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2 comments on “Emergency Room – Obligation to treat uninsured patients

  1. I thought county takes those with no other place to go.

    sometimes they can become a creditor for bills but not if no blood in the turnip…

    but I don’t think they kick out someone in real need of hospital care…

    • On this website, I don’t use what I “think.” I go by what I can find in the law or actual insurance company brochure. If you have something concrete that shows the County will pay all expenses, please provide that citation and we can analyize it.

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