Co-pays in the ER

Specialties Emergency

Published

We have been told our registration clerks will be starting to collect insurance co-pays from pt's after services are rendered. Just wondering if any other ER's out there are doing this and how it is working. I can foresee alot of problems with this for people are not used to having to put out any money at the time of the ER visit. The hospital is apparently not succesfully recouping this money in their billing process. Any information would be appreciated. thanks

debbyed,

Gosh we could be workin in the same ED.

It's amazing to me how people that are sooo sick when they come to the ER can suddenly become soooo hungry. Sometimes that's the first thing they say after their assessment. "I haven't eaten all day, can I have a dinner tray?"

And of course "I need one of those cab slips to get to timbucktoo". They never live any where close to the hospital.

If the pt belongs to an HMO we can collect whatever their copay is upon discharge. Even the medical assistance HMO's have copays. If they don't have cash with them they can write a check, use a charge card or take with them a self addressed stamped envelope to send their payment back.

I don't know how cooperative people are going to be and we have to treat them whether they pay or not so it may not change anything.

I also like the medical assistance pts that want prescriptions for over the counter meds(Tylenol ect) because they have no money. Mean while they have 2 packs of cigarettes hanging out of their purse and their kids playing with a Game Boy the entire time they are there.

We also had a balls to the wall Friday and the holiday weekend from hell is sure to continue on through Tues. We have no beds so we've had a lot of holds. Our day after the holiday can sometimes be worse because everyone party's hard and they don't want to go back to work Tues.

Hope yours isn't too bad or I hope your off. No such luck for me.:(

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do not forget about the legalities here. you must treat the patient before collecting money...in SC you cannot discuss payment with the patient. i personally do not believe that this should be a nursing responsibility--nor would i advice anyone (nurse) to participate in the activity due to legal ramifications;)

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KHERNSE

Copays are obtained after the pt is discharged. It is not a nursing responsiblity. They are collected by the registration clerk. The nurses do not discuss payment with the pt. Pts are always treated regardless of their ability to pay.

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Specializes in ER, Hospice, CCU, PCU.

We have always figured that if we could just post someone in the waiting room with a pack of work excuses we could charge 5 dollars and greatly reduce the the number of patients seen.:)

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Originally posted by debbyed

We have always figured that if we could just post someone in the waiting room with a pack of work excuses we could charge 5 dollars and greatly reduce the the number of patients seen.:)

:D These people are the majority that comes to the ER on Thursday nights and Sunday. Never having a "True" emergency. As you give them their discharge instructions they will say "Oh yeah, I need an excuse". Sometime I just want to say....there is no excuse..... lol JUST KIDDING!!!

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Specializes in ER, PACU, OR.

Co-Pays were such a big issue........we have nothing to do with it yet?

:)

me

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Oue ED starts collecting copays in the next couple weeks. a registration clerk will meet with patients after discharge to discuss payments and make arrangements.

The hospital has actually hired an outside company to start this up. I guess the dept lost around 5 million dollars last year in uncollected copays and other monies...

maybe i will see this $$$$ in my check.. NOT !!

we are also stopping ALL cab vouchers. YEAH!

last month a lady called in to the department to have a cab voucher ready to pay for her ride in also !!!! .

we will have some bus tokens available.

No more healthy choice meals for the hungry.

crackers only.

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Our upfront charge (after Medicare rebate) is up to $90, which is explained to the pt by the receptionist before anyone sees them (unless they are a Code 1 ambulance case). So why do we still get people coming in the middle of the night because their newborn baby is "making snuffly noises and moving around" while they are sleeping? Believe me, a co-payment makes no difference to the amount of rubbish you will get through the door!

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:p Our hospital also wants the nurse to escort the patient to the registration/cashier's area for "financial" checkout after the discharge paperwork is signed. We have increased our collection of debt - which may not directly impact my paycheck - but with hospitals going belly up because of finances... at least I have a job and a place to work. Another thing they have started doing is showing the bill for services to self-pay (read: no insurance or funding) patients, and giving them 48 hours to make an offer to pay something (priceline.com in the ER !). My understanding is that any amount of money is preferable to nothing... Haven't heard whether this has worked yet or not. I'll let you know. I don't have a problem escorting any one to the registration, and I have had only 1 patient's family get nasty (told me "Bill me, they always just bill me!"):p
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Hey DanRN - please don't stop those cab vouchers at my facility - otherwise THESE PEOPLE WILL NEVER LEAVE!!!!! You know, the ones you can triage without really even talking to them? Yeah, they are banned from the facility, but when they show up with a claim of cp, we Have to treat them.

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Specializes in ED staff.
Originally posted by fiestynurse

Are you kidding!! Here, unless it is a life or death situation, we get co-pays before we'll even look at them. And we most certainly collect before they leave. Usually a family member is available to help out.

It's a COBRA violation to ask for money BEFORE you render treatment, you cannot even ask the patient to sign a promisory note before they are treated... you could turn your hospital in and make some major bucks, but whistleblowers are frowned upon, though protected by law from being fired. You could point this out to them and score some points for yourself :)

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Specializes in ER.

Is anyone willing to share the difference in how much money they were able to collect after starting copays, or by mentioning the outstanding balance at each er visit?

Or is anyone willing to post or email me the name/address of their hospital so I can contact them directly. Of course I will not mention where I got the info if you wish to protect your identity.

I think this is an excellent idea, but would like some numbers to approach admin with.

Email me at canoehead

Thanks, this would be much appreciated.

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