Co-pays in the ER

nursepotter05, RN · Feb 19, 2005

The ER I work for started collecting copays on the patient's way out. I work for a children's ED,so people are probably better about paying when it is their children's care. We really don't have that many problems with it. We have the patient's go to a exit station where registration collects the money.

dspring, RN · Feb 19, 2005

I have mixed feelings regarding co pays in the ER. Part of me would love to see them considering the fact that many of the cases that shouldn't be in the ER wouldn't be if THEY had to pay for their care. Think about the people on Medicaid that never have to pay a cent for their care. I hate to sound mean, but if they would have to pay a $5-$10 co pay many of them would not use the ER like they do. I'm talking about the people that come to the ER for things I wouldn't even see my family Dr for. Had one woman call the squad for a superficial cut on her hand. Would she have done that if she had to pay for it? The part of me that don't like the idea is the hassle it would create for our poor registration people.

PA-C in Texas · Feb 20, 2005

Has anyone looked at a typical ER bill lately? It makes me feel guilty.

The ones I really feel sorry for are the ones who can only afford to send in $20 per month, but never miss a payment. They get a $700 bill for suturing a minor lac, and you just feel like you are adding to their poverty. I am talking about the honest, hard-working, responsible ones who are poor but have the character to resolve their debts. They make a real effort, and the $20 may be a lot of money for them.

NYSTATEOFMIND · Feb 21, 2005

I know all of you are compassionate and caring, you are nurses. There are those who will ask for meal trays that should not have them, but we must still recognize those who may be less fortunate and truly need food. In fact the transients have usually only shyly asked me for a sandwich and something to drink and are most grateful for this help. I have even given them my own lunch a couple of times. We might order a tray for someone clearly homeless, or a patient with diabetes who needs their insulin or has spent an inordinate amount of time in the ED for a workup. The masses have truly abused the taxi voucher availability and yes they had to get rid of this means of transportation and offer occasional bus tokens. The co-pays are difficult, they want the nurses to escort the patient to the front desk to pay, but the nurse can not spend time waiting for the patient to get dressed to be discharged, wheel or walk them to the cashier/receptionist, while running a full arrest in another room, starting IV's, administering meds, answering the phone, ordering labs, etc. Someone else has got to be the money monitor, not the nurse. If the patients are not escorted they tend to walk out with the paperwork. Someone said, "hold onto their insurance card if they had one," and once they pay, they get the card back. About the self-pays, some do hand you a $100 bill and some don't. It never hurts to ask.

kaycee · Feb 21, 2005

We never ask for money or collect co-pays. We point them in the right direstion or the financial counselor comes to see them in the room if they have no insurance and sometimes collects $50. If they skip out, so be it, I don't have time to make sure they pay, nor should it be my job or any nurses job in my opinion to do so.

FutureNrse · Feb 21, 2005

I have mixed feelings regarding co pays in the ER. Part of me would love to see them considering the fact that many of the cases that shouldn't be in the ER wouldn't be if THEY had to pay for their care. Think about the people on Medicaid that never have to pay a cent for their care. I hate to sound mean, but if they would have to pay a $5-$10 co pay many of them would not use the ER like they do. I'm talking about the people that come to the ER for things I wouldn't even see my family Dr for. Had one woman call the squad for a superficial cut on her hand. Would she have done that if she had to pay for it? The part of me that don't like the idea is the hassle it would create for our poor registration people.

Usually, the social worker in me forces me to defend those on medicaid. But in this case, I agree with you. I'm not saying that medicaid recipients are the only one who do these things, because it's clear that all types misuse the ER. I think it would be a good idea if they were required to pay a copay. Again, it would have to be after services are completed, and they couldn't be turned down of course if they're unable to pay. But if there is say...a $10 copay for medicaid users to go to the ER, that might provide a lot of revenue. It should be handled at discharge, and if they say that they cannot pay it at the time, they should be asked what they can pay at that moment. It can be explained, that if they pay in full right then, it is only 10 dollars, if they pay nothing at that time, they will be billed $20, if they can at least pay $1.00 at that time, then they will only have a $5 penalty.

They should be given 30 days to pay. If they have not made a payment within that time, interest will be imposed.

This would work even better if they were told that if they do not pay the $10 within 30 days, they will have $20 deducted from any cash aid they receive. But of course the county and state would need to be in on it then.

Those are just some ideas I had. I would like to see everyone be made to pay something. Costs would fall so quickly if folks just stopped treating the ER like it's a free clinic.

Also, making medicaid patients pay a copay, would seriously reduce the amount of frivolous visits. I doubt that it would create any problems for the real patients because the kind of people that abuse the system, might stay away if there's a copay, but not to the point of putting off a real emergency. I know the mind set, from working social services, and if they're truly ill, they will come because they think they can talk thier way out of the copay if they need to.

Okay, I'm rambling now, sorry :rolleyes:

FutureNrse · Feb 21, 2005

Has anyone looked at a typical ER bill lately? It makes me feel guilty.
The ones I really feel sorry for are the ones who can only afford to send in $20 per month, but never miss a payment. They get a $700 bill for suturing a minor lac, and you just feel like you are adding to their poverty. I am talking about the honest, hard-working, responsible ones who are poor but have the character to resolve their debts. They make a real effort, and the $20 may be a lot of money for them.

I can understand that, I'd feel bad for them as well. All we can do, is hope that Karma really works and that they'll be repaid in some way for being of good character.

When I first moved to where I live now, I had to go to the ER and I didn't have insurance. When I informed the lady at the registration window, she gave me a stack of papers to fill out about my financial situation. I just assumed that it was for billing, so that they could see what I'd be able to pay. But after I turned it back in to her, she gave me some more paperwork that turned out to be information about many programs that help the uninsured. What they do, is give all of the paperwork to a social worker, who uses your info to find a program to pay part or all of your bill. I thought that they were wonderful, they made it all so easy. I had been stressing about the cost since I left home to go to the ER, and within 30 minutes of getting there a social worker came out and told me that she'd call me the next day to finish up some details but not to worry because she had it covered, I wouldn't have to pay for anything.

Maybe all hospitals do something like this, I don't know, I'd just never heard of such a thing. The social worker even called me early the next morning to see if I'd been given any prescriptions, because she could help with those too. I did have one, but it was inexpensive and I handled that on my own.

Another alternative, for those like the family you mentioned, is for the hospital to "adopt" a different family every week. The financial dept could choose a worthy candidate once a week, someone who is paying the bill on time. A notice can be put up, explaining what you want, and directing staff and even visitors, to stop by the financial office and make a donation for the family of the week. Something can be set up to collect pocket change, as every little bit helps. It's just a thought, because I was imagining if every staff member at an average hospital were to donate only a dollar, it would be quite a bit.

Okay, I'll put my problem solving to bed now :rolleyes:

teeituptom, BSN, RN · Feb 23, 2005

I never think of it, after reatment they all get escorted to the discharge desk aka collections desk,,,,Its someone elses problem not mine.

I cant worry about everything in this world

keep it in the short grass ya'll

TinyNurse, RN · Feb 26, 2005

interesting that you asked.........

at my ER in Ohio copays were NEVER asked for........LARGE ER.

I got my first travel nurse position in TN, and it was standard........

I once got heat from my manager because I told a clerk......" she's really sick, can't she just leave".................

ER copays suck as far as I'm concerned.

Now,,,,,,,,if i'm in the ER, and i have to pay my 50 copay i don't mind, but if i can barely lift my head to grab my visa, then it sucks for people to be asking for money......... can't they just bill me?

teeituptom, BSN, RN · Feb 26, 2005

I just tell them to bill me

what can they do

nghtfltguy, BSN, RN · Jul 26, 2007

wow, very interesting thread~

i must agree w/ PA-C in Texas.

ER billing can be crazy! there are many ppl out there who truly cannot afford some of the crazy stuff we do that do not have insurance.

2 tylenol.. 18 dollars! gimme a break.. and that $700 for suturing a minor lac is crazy, yet it happens every day. what really gets me is the ppl that get billed for our helicopter service. ppl that end up in a bad mva get to fly in the whirly bird and get billed an ungodly amount of money..it saddens me quite often. i can tell that certain ppl that don't have insurance cannot afford to pay thousands of dollars for a 15 min trip in a helicopter. not to mention the thousands more they get charged after we treat them. there is this nurse that works in our hospital that came from germany and she was telling me that all people over there revieve free medical care. paid by the government. i couldn't hardly believe it. we have medicare and medicaide here in the states but its crap if you ask me. it is a system that don't really work properly and health insurance is expensive!

oh.. and by the way... I HATE YELLOW STICKERS!!

:cool:

vamedic4, EMT-P · Jul 27, 2007

I just tell them to bill me
what can they do

There ya go...

And there are times when $150 copay is hard to come by ya know. Yes, $150. That's a lot...I wish these still were the days of $50 ER copays...wouldn't that be a treat.