Life-Saving Treatment: Hospitals' Duty To Those Without Insurance

In the United States, the Emergency Medical Treatment and Labor Act (EMTALA) ensures that anyone with a life-threatening condition must be given treatment, regardless of their insurance coverage or ability to pay. Under EMTALA, hospitals with emergency departments that receive Medicare funds (which includes most US hospitals) are prevented from refusing to treat patients. This means that hospitals must conduct a medical screening examination to determine whether or not a patient has an emergency medical condition. If the patient is deemed to have such a condition, the hospital must either provide necessary stabilising treatment or transfer the patient to another hospital, or both. However, it's important to note that uninsured patients will still be billed for all medical services received and may face full, out-of-pocket costs.

Hospitals must treat life-threatening emergencies, regardless of insurance status

In the United States, the Emergency Medical Treatment and Labor Act, or EMTALA, ensures that anyone with a life-threatening emergency receives treatment, regardless of their insurance status. This federal law applies to all hospitals that have emergency departments and accept Medicare payments from the federal government, which includes most hospitals in the country.

An emergency is defined as any situation that is severe or life-threatening, causes serious impairment to bodily functions or organs, or involves imminent childbirth for a pregnant woman. Examples include a broken bone, which could cause serious dysfunction of a bodily organ if left untreated, or contractions in a pregnant woman, where there is not enough time to safely transfer her to another hospital before childbirth.

Hospitals are required to conduct a medical screening examination to determine whether a patient has an emergency medical condition. If the patient is deemed to have such a condition, the hospital must either provide "necessary stabilizing treatment" or, in certain circumstances, transfer the patient to another hospital, or both. Necessary stabilizing treatment refers to medical treatment that ensures the patient's condition is unlikely to materially deteriorate during the transfer.

While hospitals are required to treat life-threatening emergencies regardless of insurance status, uninsured patients will be billed for all medical services, which can be extremely costly. Hospitals may offer discounts or financial assistance programs to help patients pay their bills. It is recommended to negotiate bills before hospitalization, if possible, and to inquire about financial assistance programs, which non-profit hospitals are required by law to offer to low-income patients.

EMTALA ensures emergency treatment, but uninsured patients pay full bills

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires hospitals to provide treatment to patients requiring emergency medical attention, regardless of their insurance status. This law was enacted to prevent "patient dumping", where uninsured patients were transferred from private to public hospitals for financial reasons, without consideration for their medical condition. EMTALA covers hospitals that have emergency departments and accept Medicare payments, which is most hospitals in the country.

Under EMTALA, hospitals have three main obligations:

• Medical Screening Examination (MSE): Hospitals must provide a screening examination to anyone who comes to the emergency department and requests treatment, to determine if an emergency medical condition exists. This screening cannot be delayed by inquiries about insurance or payment methods.
• Treatment or Stabilization: If an emergency medical condition is identified, the hospital must provide treatment until the condition is resolved or stabilized. If the hospital lacks the necessary capabilities, the patient must be appropriately transferred to another hospital.
• Accepting Transfers: Hospitals with specialized capabilities are required to accept transfers of patients needing those services if they have the capacity to treat them.

While EMTALA ensures that hospitals provide emergency treatment, it does not cover the costs for uninsured patients. These patients are still responsible for the full cost of their treatment and may have to pay out-of-pocket or seek other options like charity care, payment plans, or Medicaid.

EMTALA Protections and Scope

EMTALA defines an emergency medical condition as a situation where the absence of immediate medical attention could result in serious jeopardy to a person's health, severe impairment of bodily functions, or dysfunction of bodily organs. It also includes situations involving childbirth for pregnant women.

EMTALA applies when an individual "comes to the emergency department" of a hospital. This includes not just the physical space of the department but also areas within 250 yards of the main hospital buildings, such as the parking lot, sidewalk, or driveway.

EMTALA Violations and Penalties

Hospitals and physicians can face significant penalties for violating EMTALA. The Centers for Medicare and Medicaid Services (CMS) has a portal for filing EMTALA complaints. The Department of Health and Human Services (HHS) can impose civil monetary penalties on hospitals and physicians for refusing to provide stabilizing care or appropriate transfers. Physicians may also be excluded from Medicare and state health care programs, and hospitals may have their provider agreements terminated.

Uncompensated Care and Its Impact

A large portion of the care provided by emergency physicians is uncompensated or under-compensated, leading to financial losses. According to the Centers for Medicare & Medicaid Services, 55% of an emergency physician's time is spent providing uncompensated care. EMTALA-mandated care is a significant contributor to this issue.

While EMTALA ensures that hospitals provide emergency treatment to all patients, it does not address the financial burden faced by uninsured individuals. This can result in full out-of-pocket payments or the need to explore alternative options for covering medical expenses.

Uninsured patients can negotiate hospital bills and receive financial assistance

Hospitals are required to treat patients in life-threatening emergencies, regardless of their insurance status. This is backed by the Emergency Medical Treatment and Active Labor Act (EMTALA), which applies to hospitals that have emergency departments and accept Medicare payments from the federal government. EMTALA also states that patients cannot be denied treatment based on their insurance status, ability to pay, race, colour, national origin, sex, religion, disability, age, or citizenship.

If you are an uninsured patient, you can negotiate hospital bills and receive financial assistance. Firstly, it is important to start the process early. Contact the billing department, your healthcare provider's billing agency, and your health insurance company as soon as you receive a bill. You should also avoid paying upfront with a credit card, as hospital bills are generally not sent to collection agencies immediately, giving you time to negotiate.

Secondly, check for errors on your medical bill. Billing disputes due to errors are common, with some reports estimating that up to 80% of medical bills contain errors. Common errors include being charged twice for the same procedure, being billed for services you never received, or being billed for a more expensive treatment than you required.

Thirdly, ask about financial assistance programs. The federal government and state laws require many hospitals to offer financial assistance to patients who cannot afford their medical bills, as long as the service is deemed "medically necessary". Nonprofit hospitals, in particular, must have written policies establishing eligibility criteria for financial assistance under the Affordable Care Act (ACA). To apply for financial assistance, you may need to provide information about your budget, assets, tax returns, and proof of income.

If you do not qualify for financial assistance, you can still negotiate a lower bill. Research the "insured rate" for the services you received, as insurance companies often negotiate lower prices with healthcare providers. Contact the hospital billing department and politely ask them to match the insured rate. Additionally, many hospitals will offer a discount if you can pay the bill upfront.

Finally, if you are unable to negotiate a lower bill, you can still request a payment plan to break down your medical bill into more manageable monthly installments. Hospital and clinic bills are usually interest-free, making them more affordable in the long run compared to paying with a credit card.

Hospitals must assess if an emergency medical condition exists

Hospitals are required by law to assess whether an individual has an emergency medical condition. This is true regardless of the individual's insurance status or ability to pay. This law is known as the Emergency Medical Treatment and Labor Act (EMTALA), and it applies to hospitals that have emergency departments and accept Medicare payments from the federal government.

EMTALA mandates that hospitals must provide an appropriate medical screening examination to determine if an individual has an emergency medical condition. This examination must be conducted by a qualified professional and cannot be delayed due to inquiries about insurance or payment methods. Hospitals must also provide clear signage notifying patients of their right to this examination.

If an individual is found to have an emergency medical condition, the hospital must provide treatment until the condition is stabilized. "Stabilized" means that the individual's condition is unlikely to get materially worse. If the hospital lacks the necessary staff or facilities to stabilize the condition, they must appropriately transfer the patient to another hospital that can provide the required care. The transferring hospital must explain the benefits and risks of the transfer and ensure that the receiving hospital has the necessary staff and facilities to stabilize the patient's condition.

EMTALA defines an emergency medical condition as a problem that has arisen quickly, often referred to as an "acute condition," and for which the patient's symptoms are so severe that failing to give immediate medical attention could reasonably be expected to result in serious health jeopardy, serious impairment of bodily functions, or serious dysfunction of any bodily organ or part. This definition includes situations where a pregnant woman is in active labor and there is insufficient time to safely transfer her to another hospital before childbirth.

Hospitals that fail to comply with EMTALA may face penalties, including civil monetary penalties, exclusion from Medicare and state health care programs, and potential lawsuits if the denial of treatment leads to greater harm or death.

Hospitals must treat until the emergency medical condition is stabilised

In the United States, the Emergency Medical Treatment and Labor Act, or EMTALA, ensures that hospitals treat patients with emergency medical conditions until their condition is stabilised, regardless of their insurance status. This federal law was enacted in 1986 to address the issue of hospitals discharging patients prematurely and refusing to treat low-income individuals with medical emergencies. EMTALA applies to hospitals with emergency departments that accept Medicare payments from the federal government, which includes most hospitals in the country.

EMTALA mandates that hospitals provide three main services to patients:

• An appropriate medical screening exam: Hospitals must conduct a medical screening examination to determine whether a patient has an emergency medical condition. This examination must be offered to all patients, regardless of their insurance status or ability to pay, and cannot be delayed by inquiries about payment or insurance coverage.
• Treatment until the condition is stable: If a patient is found to have an emergency medical condition, the hospital must provide treatment until the condition is stabilised. This means that the patient's condition must not materially worsen or deteriorate during their time at the hospital or during a transfer to another hospital.
• Appropriate transfer to another hospital if necessary: If a patient's emergency medical condition cannot be stabilised at the current hospital, they must be appropriately transferred to another hospital with the staff and facilities to stabilise their condition. Before transferring, the hospital must explain the benefits and risks of the transfer.

EMTALA defines an emergency medical condition as a problem that arises quickly and presents with acute symptoms of sufficient severity. This includes situations where the absence of immediate medical attention could result in serious jeopardy to the patient's health, serious impairment of bodily functions, or serious dysfunction of bodily organs. Additionally, for pregnant women, an emergency medical condition includes active labour, where there is insufficient time for a safe transfer to another hospital before childbirth.

It is important to note that EMTALA does not apply to individual doctor's offices or medical groups that do not have an emergency department or emergency room. Furthermore, not all visits to the hospital will qualify as emergencies, and hospitals may choose to transfer or discharge patients once their immediate condition has been stabilised.

Frequently asked questions