Co-pays in the ER

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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

One of my business professors used to talk about a phenomenon he called the "prostitute syndrome" - the value of the service diminishes after the service has been rendered. I have no problem with our registration folk collecting co-pays and any money they can get as quickly after the service is rendered as is humanly possible. " The best thing a business can do for it's employees is make a profit" Jack Welch

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Hi guys,

I recently went through an EMTALA investigation (no violations) and while preparing an in-service I researched a ton of information. EMTALA states you must provide a medical screening reguardless of ability to pay and you must treat and stabilize any "emergency medical condition" found. EMTALA requires that there will be "no delay in the medical screening and stabilization" of individuals presenting within 250 yards of your hospital.

However, if there is no delay in the medical screening process, you may ask and collect as desired. Don't forget you are required to do the medical screenig reguardless of their ability to pay. Remember, only those persons deligated by the medical by-laws can do the medical screening. Note: Triage is not the same as a medical screening. I hope this helps!

Catalyst

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Specializes in ER.

Within 250 yards???

So do we now have to install cameras across the street and moniter for passed out drunks? You have got to be kidding.

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When Medicaid went HMO where I live we started collecting money for services. We provided the medical screening, but if no emergency condition was determined to exist they could pay up front or see their medicaid doc in the AM.

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Specializes in ER.

Well, the patients are safe at our facility. They don't have to cash out before, during or after. The employees however, that is another story. Apparently our ER averages 44 employee visits per day...As of 1-1-02, employees with non work related visits will have a $25 copay, due upon discharge. Now, if my math is correct, that would amount to $1100 per day or, $401,500 per year, if they were all non work related of course. Even if 40% are non work related, that leaves $160,600 they didn't have last year. Perhaps that will be enough to allow them to buy us at least a CHEAP Christmas present next year, since there obviously wasn't enough to do it this year!! Thanks for all the hard work!

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I don't see how they can do that. If you visit an ER for a nonwork related problem it shouldn't matter if you work there you are a pt. like anyone else that uses the facilty. How can they discriminate like that? If they plan on collecting co-pays then it should be for everyone. I think all the employees should go to another facility when they need emergency care and let the administration know that's what you all plan to do. I'm sure they make some money on what the insurance co. pays out for an ER visit so let them know you all as "clients" are taking your business elsewhere.

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W EHAVE BEEN DOING THIS AT THE HOSPITAL WHERE I WORK FOR TWO YEARS IT WORKS WELL WE COLLECT FROM 500-2000 PER DAY WE ESCORT THE PTS OUT TO REGISTRATION WHEN THEY ARE D/C. IF THEY CAN PAY THEY WILL ITHERE IS NO PRESSURE ON THEM THE ADDED M

ONEY IS GOOD FOR THE DEPT.

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I can completely understand the hospitals needing their money, and don't disagree with a copay at all. I had just moved to Tennessee and had no checking account, and all but $19 was in a savings account. I rushed my 3 year old daughter to the ER one night with blood dripping out of her ear. She had stuck a lego toy into her ear (I know, my fault for the small peices being available to her!) They refused to see her, even though she was screaming and writhing in pain, unless I had $100 cash. I explained to them that I did have it, but it was in my savings and I didnt' have a bankcard or anything but would be glad to bring it back 1st thing the next morning.............still, they would not even look at her. I asked the nurse could she at least look into her ear and see if whatever she had stuck into it was still there or what, she said unless it was a life or death emergency or unless I had the cash they could not even look at her! Needless to say I was very irate- I understand what the emergency room is for, and I'm not a nurse YET, but I do consider blood leaking out of my 3 year old's head an emergency! Anyway- ended up taking her straight to an ER an hour away, where they treated her immediately, and just signed an agreement to pay whatever the charge would be. They mailed me a bill for $147 and I paid on receipt as promised. Thank you Sumner Regional Medical Center for being human!

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highasthesky,

We have not started co-pays in our ER yet, but when we, do we still are not allowed by PA law to refuse service to anyone, based on their ability to pay. These are insurance co-pays and it sounds like you didn't have insurance. People with no insurance are treated and billed later with payment plans if the bill is too much for them to handle at once. I didn't think any hospital could refuse treatment because the pt. didn't have money up front but I guess it's different depending on the state. I'm glad I don't live in Tennessee.

Sorry about what happened to you and your daughter, hope she was ok. It would never happen in the state of PA.

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Thank you for the sympathy. Although that was two years ago I still boil thinking about it. And Sumner Regional in Gallatin said the exact same thing, that they couldn't believe they wouldn't treat her. But that the "head nurse" was allowed to make the call on what was an emergency and what wasn't. I imagine that if it had been one of her friends or family members, she'd have considered it an emergency. So much for small town hopitals! (Not that they're all this way) And you're right, I had no insurance at the time at all. Learned a big lesson there!

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THE FACT THAT A HOSPITAL ER REFUSED TO TREAT YOUR CHILD IS AGAINST TO LAW IT IS A VIOLATION OF COBRA/AND EMTALA IF YOU WERE TO REPORT THIS THEY COULD BE FINED UP TO 50,000 DOLLARS AS A ER NURSE AND PARENT I WOULD NOT TOLERATE SUCH TREATMENT GOOD LUCK IN THE FUTURE

JIM

JE1RN

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I don't think anywhere can refuse to treat due to inability to pay....

Hi everyone...new to this BB

In our ED the registration clerks try to get the co-pay from the patients when they go to leave. To park in our ED lot you get a ticket...to get out of the ED parking lot you need a token...when you go to pass your ticket in to the clerks to get a token...guess what they ask you for??? This is fairly new for us and most of the clerks are saying that most people don't have the cash or check for the co-pay...Yes they give them a token to get out anyway.

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