Are emergency response personnel, such as paramedics, allowed to question patients about their ability to pay for service in the U.S.?
That was the question posed to us by a reader through Macon Me Curious, a new project of the Center for Collaborative Journalism in partnership with The Telegraph and GPB Macon. Macon Me Curious takes questions from the community and assigns reporters to find the answers.
Health care costs are a hot topic among politicians, patients and medical professionals, but one question is not up for debate. Emergency departments must treat anyone seeking emergency medical care, regardless of the patient’s ability to pay.
Several federal laws guarantee emergency care for those who can’t afford treatment, whether or not they’re insured. In 1986, Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA), which states that all Medicare-participating hospitals with emergency departments are obligated to medically screen and stabilize any patient in need of emergency care.
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If the hospital is not equipped to treat the patient itself, it can transfer the patient to another emergency department only once medical personnel have established that the patient is in a stable enough condition.
EMTALA specifies that hospitals cannot discriminate based on a patient’s capacity to pay, insurance status, nationality, race or religion. Hospitals or physicians that disobey EMTALA regulations can be fined $50,000 per violation or lose their Medicare certification.
Nearly all hospitals participate in Medicare and are therefore subject to EMTALA and other rules stipulated by the Centers for Medicare and Medicaid Services, said Vidor Friedman, an emergency physician and president-elect of the American College of Emergency Physicians. He said only a handful of small, specialty-specific hospitals are exempt from federal regulations.
In addition to EMTALA, nonprofit hospitals are also required to follow a specific set of rules outlined in 501(r), the IRS code for nonprofit hospitals. Beyond their inability to deny emergency treatment to patients based on insurance status or capacity to pay, not-for-profit hospitals must also have a “widely publicized” financial assistance policy, which should be available both online and inside the hospital.
The IRS code states that the financial assistance policy should outline the hospital’s eligibility criteria for free and reduced-rate care, its methodology for calculating patients’ bills, its billing policy and application instructions. Nonprofit hospitals that violate these rules can lose their tax-exempt status.
Friedman said these rules are important because they allow patients who are worried about payment to focus first and foremost on their health.
“If you’re thinking about the cost of your care, you’re not thinking about your health,” Friedman said, adding, “you need to make decisions as a patient based on what you’re feeling.”
Because of emergency care rules, patients typically don’t learn how much their treatment will cost them until after the fact. They might receive an estimate upon discharge, but because patients often receive services from multiple departments, it’s difficult to know exactly what they’ll have to pay until a bill comes in the mail.
Friedman suggested that patients who are concerned about the cost of treatment should speak with hospital staff about their options at the end of their visit.
“Most providers of care will work with you to figure out ways of making good on the services that have been rendered,” he said.
Berneta Haynes, director of equity and access for the consumer advocacy organization Georgia Watch, said patients should also know that once they receive a medical bill from the hospital, the cost of their treatment is still not set in stone.
“It’s so important for folks to be aware of their ability to negotiate and for that ability to negotiate to not be infringed upon,” she said. “There’s just so much flexibility.”
But despite all of the federal statutes in place to protect emergency room patients from discrimination, there are exceptions to the rule. Because EMTALA and 501(r) only apply to Medicare-participating hospitals, privately contracted ambulances or EMS services don’t always have to play by the same rules. Urgent care clinics are also exempt from such regulations because they are not officially considered emergency departments.
Friedman emphasized that patients in need of emergency treatment should not avoid the hospital just because they don’t know if they’ll be able to pay.
“You have to take care of your health,” he said. “In general, we can work out the payment details later, when it’s necessary to.”
Do you have a question you want answered? What are you curious about? Let us know at macon.com/curious.
Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at facebook.com/samantha.max.9 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.