Federal law gives you the right to emergency
care, regardless of your ability to pay. Here are the details
on how you should be handled at the hospital.
When you're injured and in the emergency room, the last thing
you want to have to do is fight for treatment. Fortunately,
a federal law passed in 1986 to prohibit a practice commonly
known as "patient dumping" gives you the right to
emergency care regardless of your ability to pay. The federal
law applies to hospitals that participate in Medicare -- and
that includes most hospitals in the United States. However,
the patient-dumping law does not give you carte blanche.
What you're entitled to
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.
Hospitals cannot transfer patients until their condition
has been stabilized. There are a couple of exceptions: if
a patient requests to be transferred and is fully informed
of the consequences of being moved, or if a physician feels
that the medical benefits exceed the risk of the transfer.
What is considered
an emergency situation?
According to the Emergency Medical Treatment and Labor
Act (EMTALA), an emergency medical condition means:
(A) a medical 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 health of the individual (or, with
respect to a pregnant woman, the health of the woman
or her unborn child) in serious jeopardy
serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part;
(B) with respect to a pregnant woman
who is having contractions:
that there is inadequate time to make a safe transfer
to another hospital before delivery, or
that transfer may pose a threat to the health or safety
of the woman or the unborn child.
For instance, if a hospital is not equipped to deal with
a trauma case, the emergency room physician may transfer the
patient to a hospital that has a trauma center. Patients themselves
sometimes will want to go to another hospital, either because
they prefer that hospital or because their doctor is there.
If you ask to be transferred to another hospital before your
condition is stable, you'll most likely have to sign a form
to show you've given your informed consent.
What you're not entitled to
If you're not having an emergency, then the hospital emergency
room does not have to treat you. The hospital most likely
will direct you to your own doctor or to a less-intensive-care
setting, such as a community health clinic.
The patient-dumping law was passed to make sure that people
in distress get the necessary medical attention. The question
of payment, however, is between you and your insurance company.
If you don't have health insurance, then you still will have
to make payment arrangements with the hospital.
Once your condition has stabilized, the hospital also has
the option of moving you to another facility.
Managed care and emergencies
The Department of Health and Human Services says that the
patient-dumping law also applies to HMOs that illegally demand
pre-authorization for emergency room visits. Emergency room
care cannot be delayed while a hospital tries to obtain pre-authorization.
State by state
Individual state regulations also have a bearing on the way
you're treated in an emergency room, and upon your health
insurer's decision to pay for that treatment. The federal
law allows you basic rights, and your state laws may provide
you with some additional rights. If you feel that 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 that your insurance company is unjustly denying payment,
try your state's insurance department.
Some states also have a regulation that requires insurance
companies to pay for emergency room care if a "prudent
layperson, acting reasonably," would have considered
the situation a medical emergency.