Co-pays in the ER

Specialties Emergency

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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

Originally posted by kaycee

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.

I live on Oahu, HI, and we are not allowed to refuse care to anyone. In fact, most patients that come to the ER come there because they don't have insurance. When patients come into the ER registration is not even allowed to see them until the nurse has seen them first or placed into a room. Refusing treatment to a patient in the ER is a COBRA violation. How does some hospital get away with it. I'm glad don't live in Tennessee either!!!

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After hearing from all of you, if I had've known that it was against the law for them to refuse us, I probably could've done something about it. I did mention placing an article or column in our local paper, because they had also refused an 11 month old around the same time, he was running a temp of 103 and dehydrated, they told his mother to take him to his pediatrician the next morning. But I was told that I could be sued for slander, and being new to Tennessee and not knowing much about the law, I was sure they were right and didnt' want to take a chance. Now I wish I had've taken the chance and investigated more and found out exactly how many people have been turned away in dyer need. Thanks for all of your responses.

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Specializes in Emergency Room.

CO-PAYMENT IN THE ER IS THE RIGHT THING TO DO...IF YOU GO TO AN URGENT CARE, YOU CAN'T GET SEEN UNLESS YOU PAY...WHY SHOULD HOSPITALS HAVE TO PROVIDE FREE SERVICE?

A WOMAN CALLED ONE NIGHT ASKING HOW LONG THE "WAIT" WAS (AND HOW MANY WILL THERE BE IN YOUR PARTY TONIGHT, M'AAM?)...AND I TOLD HER WE WERE SWAMPED. SHE SAID IT WAS FOR HER DAUGHTER WHO HAD A SORE THROAT. I SAID, IF IT IS NOT A REAL EMERGENCY, MAYBE SHE SHOULD TAKE THE KID TO AN URGENT CARE...SHE SAID SHE COULDN'T AFFOR THE CO-PAY!! (GRIND YOUR TEETH HERE)!:devil: :(

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I'm grinding!!!!! Our ED only re-coops about 42% of cost - kindof like a giant sucking chest wound. It is sad that we are most of america's only alternative.

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It is not a matter of treating the patient first then asking for a copay, but a matter of determining that a medical emergency does not exist, that the patient is stable, by means of a medical screening examination (MSE). There is no obligation to treat, but there is an obligation to provide the MSE and appropriately refer the patient.

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Specializes in emergency nursing-ENPC, CATN, CEN.

We also have our registration group do bedside registration after the pt has been seen by the physician-don't want EMTALA problems. If pt is not able to or incompetent, they will try to find family, etc. At discharge , after the pt. receives their instructions, they stop at the discharge desk where their registration info is verified, copays collected. If unable to pay at that time, they will be billed. It is working out well.

Anne

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Correct: Emtala requires a medical screening exam by dr or otherwise denoted MSE officer, not delayed by money issues. If no delay is caused by that discussion: no problem exists. If all treatment areas are all full and patients have to wait anyway, it is ok to have the money talk. All patients get a medical screening exam if they want one, regardless of funding issues. Just don't delay them getting to MSE due to $$$.

Emtala requires stablization of medical emergency only: it does not mandate treatment for non emergency. No emergency: no care required under emtala. If no Emergency, there is no EMTALA issue. But be careful medical screening exam is adequate!

EMTALA also covers transfer issues to prevent lack of funding in determing emergent care as well.

I am all for requiring payment for nonemergent issues but it isn't the nurse's priority to get them to the cashier or deal with financing issues. Go get 'em, business office!

The abuse is overloading the system and more cost effective clinics must be devised, especially for the underfunded. I am sick of being yelled at by the nonpaying desiring immediate care nonemergent issues when I can't get a room & a nurse open to care for the really sick who need our sevice. Patience and mercy are good things, but the sick should be cared for first, then the nonurgents..... I am for closing our fast track and catering to the sickest first again, and turn all the beds into ED beds again. We have been thru an awful month because of full capacity on the floors and holding almost a full ER for admits beds day after day. It has been chaotic, and potentially unsafe. Time for some priority setting! Emtala we can do, treating everyone free we can't.

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Co-Pays??? Insurance????Money????

Gee, I thought the ER was just a free walk-in clinic. You mean there are people out there who actually pay for the services received???

Sorry, Couldn't help myself. Out of the 63 patients that came through the doors last evening/night I had 22 ask for a meal tray (Note we are talking about 7p-7a), 13 ask for a weeks supply of medicine, and a wopping 17 ask for cab vouchers.

We have a large number of patients who call 911 (some even take a bus ride so they are in the right area than call 911), ask for a meal, ask for their drugs than expect us to send them home is a cab.

Please sent these Co-payment angels to us. If we start asking for money maybe they will take a bus to someone else's area instead.

Please note, none of these patients had a life or limb threating illness/accident. People who are truely sick can have anything I can give them.

Guess you figured, last night was a holiday weekend night from H@&L.:eek: :( :confused:

Are you serious? I didn't even know any of things were possible. I've been to the ER, for myself, and for my kids, many times over the years and it never occured to me to ask for a meal. Even if I've been there for hours and haven't eaten all day, I never considered such a thing. Heck, I feel bad bugging a nurse for a drink of water. Cab Fare? Hospitals actually do this? Why? That's absurd. And a weeks supply of meds? Sheesh. Does someone print up a list of these possible freebies and hand them out to the poor, uninsured, or just plain cheapskates?

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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.

Good! Medical professionals have better things to do than deal with these things anyhow. Imagine if you added up the time you spent in an average week, dealing with requests for food. From start to finish, I bet it really adds up. Patients are waiting, and complaining because valuable time is being wasted because Ms. So-and-So came to the ER, well enough to eat but didn't bother to fill her stomach before she left home.

It's simply not your problem.

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Obviously, this is a huge issue with many levels, many causes, and no easy answers. I'm sure everyone would like to see these bills being. I'm also sure none of you want to see the ill go untreated.

Health insurance is one of the biggest issues, and I've yet to hear of a plan that will make it easy for everyone to have affordable healthcare.

Poverty is another problem. Some people cannot afford any healthcare at all.

Ignorance is the biggest problem of all. Some people were raised on using the ER for everything, now thier children are grown and bring thier own children to the ER for everything. They don't know any different. Going to the ER is what you're supposed to do as far as they know. Some think that hospitals are these big money making institutions that can afford to treat them for free. They can't begin to comprehend how many others think the same way and how that adds up. They don't understand that everything they do, or receive in the ER costs money, from the cost of paying the staff, to the cost of medical supplies, right down to the cost of that little plastic ID bracelet they're wearing.

Changes need to be made. We all know that. I liked the post I read about an ER no longer giving out meals and cab vouchers. It's a small thing, but it adds up. I think that part of the D/C process should include trying to collect a co-pay, and a reminder a past due bill is not out of line. People need to be made to be accountable because it does not come naturally to too many. Billing should spend more time trying to collect from patients. I for one know that they don't always give it a lot of effort. I was uninsured once for about 2 months and during that time my son got hurt playing football (again) and we ended up in the ER. We never got a bill. I called billing and was laughed at, the man I spoke to said "We didn't bill you and you WANT us to?" It wasn't really that I'm such an honest person or anything, truthfully I was worried that I'd get turned in to a collection agency because maybe they had the wrong address or something. But, the guy checked into it for me and had no record of me owing anything. I still haven't received a bill over a year later. I'm sure that it would've been a hefty bill too, but somehow I fell through the cracks in an obviously VERY cracked system.

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Our copays are working well. People are getting used to it and most pay on the spot after discharge. Those with no insurance are asked to pay $50 toward their bill. That is rarely collected, but they have to see a financial counselor before they leave to discuss alternate ways to pay their bill depending on their circumstance. We cannot refuse tx in the ER, because of outstanding bills but they can refuse outpt procedures and believe me they do.

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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.:)

That is a fabulous idea! :)

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