payment before care of nonemergent pts - page 2

About 2 years ago, some hospitals in my city moved towards getting payment from non emergent pts before they received treatment in the ER. The pt would get triaged, then receive a "quick medical... Read More

  1. by   rehab nurse
    i don't work in ED/ER, i work rehab. however, i did have to take my 3 y.o. ds to the urgent care clinic that her ped's office runs out of the hospital. he was ill for several days, with a fever, over a holiday weekend so i was in contact with the group physician on call and their nurse who is on call. i eventually had to take him there, and before i could be even seen by a triage nurse or a physician, i had to pay 100 dollars upfront. you sign in, like a regular office, fill out paperwork while they take your insurance card and license, and then you are taken to a payment room before you are brought back to a waiting room.
    i was not used to paying at an er or urgent care clinic, usually i am billed, so i was thankful that i had my checkbook with me or otherwise i would not have been seen, and it ended up my son had an ear infection in both ears and a sinus infection. his first ever infection and he would have had to wait another day or two to be seen if i would have forgotten my checkbook before my 45 minute drive to the urgent care clinic/hospital. that would have really upset me.
    my kids pediatrician works out of a different hospital than i work with, so i was not familiar with it's payment process. our er's do not do this yet, however, they do come around to you while you are in the er waiting with a little mobile cart/computer and collect your address/demographics for billing if the situation permits. but they don't collect payment.

    just wanted to tell you what happened to me and my son from a mom's perspective. thank god i had my checkbook that day or my poor son would have been in misery another two days. i didn't mind paying the fee upfront, although i could see how some people would not like having to pay a big fee right away. i know there were times when my kids were very young that i didn't have money in the bank, i lived paycheck to paycheck, and with copays and fees rising, some people may not be able to pay a large fee the day of service.
  2. by   TazziRN
    Quote from firstaiddave907
    But how does the hosptail determin who would get charged and who wouldnt get charged. would someone get charged if they came in with a smiple cold where if a pacient came in with possible appendicitis they wouldn't get charged?
    If I understand it correctly, a non-urgent pt (a cold) would be told after a screening that they do not have an emergency but should they still want to be treated in the ER they will have to pay the copay first. ER copays are generally higher than office/clinic copays. This gives the pt a choice.
  3. by   Altra
    Quote from rehab nurse
    i don't work in ED/ER, i work rehab. however, i did have to take my 3 y.o. ds to the urgent care clinic that her ped's office runs out of the hospital. he was ill for several days, with a fever, over a holiday weekend so i was in contact with the group physician on call and their nurse who is on call. i eventually had to take him there, and before i could be even seen by a triage nurse or a physician, i had to pay 100 dollars upfront. you sign in, like a regular office, fill out paperwork while they take your insurance card and license, and then you are taken to a payment room before you are brought back to a waiting room.
    If I am reading your post correctly, your visit was to a clinic, not an ER in the traditional sense. So because you were not seeking emergency medical attention, the paperwork/payment process was more like an office visit. Otherwise, requesting payment/insurance info from you before you were seen at least by a triage RN would be a major violation of EMTALA.
  4. by   Altra
    Quote from TazziRN
    If I understand it correctly, a non-urgent pt (a cold) would be told after a screening that they do not have an emergency but should they still want to be treated in the ER they will have to pay the copay first. ER copays are generally higher than office/clinic copays. This gives the pt a choice.
    Interesting ... I would be very curious to see data on how many non-emergent patients end up leaving when told about the $150 fee, and whether or not this potentially unbilled MD/CRNP/PA "screening" is more cost effective than treating any & all comers with the percentage that have no insurance at all or will never pay their co-pay.

    To the OP: do have any further info on what types of patients are funneled into this system? Is it only the obvious colds/flus/sniffles/boo-boos? What about a strep throat that is not emergent, but should be treated w/abx now rather than later?
  5. by   rehab nurse
    Quote from MLOS
    If I am reading your post correctly, your visit was to a clinic, not an ER in the traditional sense. So because you were not seeking emergency medical attention, the paperwork/payment process was more like an office visit. Otherwise, requesting payment/insurance info from you before you were seen at least by a triage RN would be a major violation of EMTALA.
    this is a pediatric emergency care clinic, that is in front of the regular ER for adults and is run by the pediatric doctors/NP group that my kids go to. It's actual title says "Lakeview Emergency Care Clinic". I guess it's kind of an unusual title as it says both clinic and emergency in it. I had never been to it before. My kids were never ill enough to warrant such attention after hours. And I have to go to my own hospital ER for my care, which is why I was not used to the setup. Maybe it is a clinic, but the title suggests emergency care is available, and it is just a few floors away from PICU, NICU and the main campus hospital, and in front of the adult ER. I am not competely familiar with EMTALA, as I don't work ER. Thanks for informing me that maybe it is set up to work as an office/clinic. However, do EMTALA rules affect urgent care clinics? Or just Emergency Rooms/Departments? Now I'm really confused about their set-up. It says both Emergency and Clinic in the title, which contradict each other. I'm sorry if I really messed up your thread with my post. I just wanted to post what happened when I brought my son to this place. Sorry
    However, let me say thank you to you ER nurses who take such good care of me! As someone who is sent to the ER pretty often, I thank you for knowing so much information to care for everyone with so many different diseases/illnesses. I couldn't do it!
  6. by   Altra
    Quote from rehab nurse
    this is a pediatric emergency care clinic, that is in front of the regular ER for adults and is run by the pediatric doctors/NP group that my kids go to. It's actual title says "Lakeview Emergency Care Clinic". I guess it's kind of an unusual title as it says both clinic and emergency in it. I had never been to it before. My kids were never ill enough to warrant such attention after hours. And I have to go to my own hospital ER for my care, which is why I was not used to the setup. Maybe it is a clinic, but the title suggests emergency care is available, and it is just a few floors away from PICU, NICU and the main campus hospital, and in front of the adult ER. I am not competely familiar with EMTALA, as I don't work ER. Thanks for informing me that maybe it is set up to work as an office/clinic. However, do EMTALA rules affect urgent care clinics? Or just Emergency Rooms/Departments? Now I'm really confused about their set-up. It says both Emergency and Clinic in the title, which contradict each other.
    ...
    However, let me say thank you to you ER nurses who take such good care of me! As someone who is sent to the ER pretty often, I thank you for knowing so much information to care for everyone with so many different diseases/illnesses. I couldn't do it!
    EMTALA states that emergency medical screening cannot be delayed to obtain insurance/payment info, so in an ER setting, you are at a minimum assessed by a triage RN before the nitty gritty details of payment/
    insurance come into play.

    I agree, the name of your "Emergency Care Clinic" is confusing. Hard to say if it's the pediatric portion of that hospital's ER (ours is physically separate from the adult or "main" side also) or if it is a walk-in urgent care center. Again, if it is part of the hospital's ER, then I'm very sorry your son's care was delayed, because from what I'm reading here that would seem to be a clear violation of EMTALA. EMTALA carries stiff penalties -- the 2 hospitals where I've worked in the ER go above & beyond to make sure that registration/triage procedures never interfere with or even give the appearance of delaying care.

    Thanks for all that you do.
  7. by   JessicRN
    great in theory: pay before you treat but where I work we would have no patients doing that would drive everyone to us. We are a public health hospital we treat indigent,illegal and mass health mainly. NO ONE has money to spend on medical care that is. Hell they won't even spring for the tylenol ordered for their ailmnent or the ABX prescription they were given. They come because they don't want to pay the copay they have to pay at the doctors office. They give false names false addresses false social security numbers.
  8. by   rehab nurse
    Quote from MLOS
    EMTALA states that emergency medical screening cannot be delayed to obtain insurance/payment info, so in an ER setting, you are at a minimum assessed by a triage RN before the nitty gritty details of payment/
    insurance come into play.

    I agree, the name of your "Emergency Care Clinic" is confusing. Hard to say if it's the pediatric portion of that hospital's ER (ours is physically separate from the adult or "main" side also) or if it is a walk-in urgent care center. Again, if it is part of the hospital's ER, then I'm very sorry your son's care was delayed, because from what I'm reading here that would seem to be a clear violation of EMTALA. EMTALA carries stiff penalties -- the 2 hospitals where I've worked in the ER go above & beyond to make sure that registration/triage procedures never interfere with or even give the appearance of delaying care.

    Thanks for all that you do.
    awww, thanks! and next week i will be going to my ped's office for my son's checkup, so i will ask him what the "clinic" really is. is it the ped's er? since it is placed right in front of the "adult" er? or is it setup as a clinic?

    thank you everyone! now, back to the topic....

  9. by   babynurselsa
    Some of the smaller town ERs that I work at do this also. They see the physician for the MSE. If the doc determines it is a non emergent c/o, they are then advised that they will need to make a $75 copay to recieve tx, or call their pcp in the am to be seen. I haven't seen it posing much of a problem overall. I think it is a fair system.
  10. by   CaseManager1947
    What we were trying to avoid was scenario #4--the walkouts. ED was losing tons of dough, bottom line in a hemorrage state, ya see. So changes were made, and I feel it's better, not perfect yet, but we haven;t been doing it very lomg either. still better than payin' the whole thing., so I anted in my $100 co-pay for my treatment, as I should do. Every little but helps in health care facilities stay open to serve u and me when we need it too. JAT.

    morghan the cdiff queen of St.joes ER.
    June of this year.(LOOOOove that Flagyl)


    good nite to all the nite owls, have a great nite to those of you hitting the sack..
    Last edit by CaseManager1947 on Aug 23, '06
  11. by   Uptoherern
    They (the notorious "theys") have implemented this in our er also. It is called an MSO (medical screen only). Children can not be "MSO'd". Basically, a pt. is triaged and then seen by the provider. (Same as other posters, a PA, NP or MD). If the provider deems this is non-urgent, they notify registration. Registration then informs pt. that they do not have an "emergent" condition, and if they want to continue tx, they must either pay their co-pay, or $100. If they stay, they get treated, if not, they leave with a list of urgent cares and "more appropriate resources".

    If they pay, more that likely the most "treatment" they get is an abx rx. Sometimes, they get nothing more than the dental referral sheet with their d/c instructions. More often than not, they elect to leave.......and boy oh boy do they get mad! I've seen them shove the registration clerks, throw things, yell & curse at us, on & on.

    I can see that the bottom line is money. When is the bottom line ever NOT money? The hospital says it doesn't violate EMTALA, because all we are required to do is give everyone a who enters the ER, an emergency medical screening exam.

    I actually had one lady get so mad, that she said she was going to call the "state" on us. She actually DID call the state, (who happened to have people in the hospital that day). the state people reviewed her records, and nothing ever came of it.

    It is always the people who come in for pain meds that get the most pissed off.

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