Co-pays in the ER

JessicRN · Jul 27, 2007

We just started that at our hospital. At discharge the pt is escorted to the registration area for checkout. At that time the registration clerk askes them to verify all their information and asks them for their co-pay. Those pt's that don't have a co-pay, when we get the registered chart it is stamped courtsey discharge on it to let the nurses know that after they leave they can just go instead of stopping, that way we are not escorting all patients to the discharge area. In the last month we have collected $11,000.00 just in co-pays or payments on outstanding bills because a lot of out pt's are repeat customers who think the ER is a free clinic. It has made a big difference seeing as before we didn't recieve any money! It has also made the pt.s that abuse the system to see that it is not free care- especially when the registration clerk says "You have an outstanding bill of $3,000, can you please pay some of this today". Before they thought we didn't even keep track!

What happens if they can't pay? Do you keep the pt? If we instigated that we would have a war as all of our patients are freecare or medicare or masshealth (illegal and poor,>62,legal and poor)half of them do not have enough money for a cab let alone co pay. :uhoh3:

jojotoo, RN · Aug 5, 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!!

Yes, this is an imperfect system that we have here, but not as bad as some people would have you believe.

How is it that Germany (or any other country) has free medical care? Oh, the government is paying for it. And just where did the government get the money to pay for it. The taxpayer. Well, I don't want my taxes to be any higher than they are now. In fact, I think I'm paying way to much as it is.

Two Tylenol costing $18? Now why would that be? Partially to cover for nonbillable expenses - like NURSING! Or housekeeping, linen, security, and probably at least a dozen other services that we don't think about. And what about the hospital making a profit? Or the shareholders? Where does the money come from to finance pension plans or the 401K? Building improvements or technology upgrades? Biomed repairs and central supply equipment sterilization? Salaries for in house education providers? ER techs, CNAS, transporters,and medical records. There's a lot going on behind the scenes that most people don't think about.

Now, as for transporting patients via those expensive helicopters. Are these trauma patients? Did somebody just wake up one day and say, "How can we increase the cost to a patient?" Or was the plan to decrease transport time over either long distances or congested areas, in order to increase the survival rate? Why do those rides cost so much? Perhaps because they are delivering highly skilled specialists to the scene.

No, our system is not perfect and we do have room for improvement, but I am grateful for the health care that is available to me.

BVFD 333 · Aug 5, 2007

Yes, this is an imperfect system that we have here, but not as bad as some people would have you believe.
How is it that Germany (or any other country) has free medical care? Oh, the government is paying for it. And just where did the government get the money to pay for it. The taxpayer. Well, I don't want my taxes to be any higher than they are now. In fact, I think I'm paying way to much as it is.
Hi,
Just wanted to clarify, Germany does not have free or government paid healthcare, we do have mandatory health insurance which is like in the USA blue Shield/ Blue Cross, only everybody has it!
Just FYI

jojotoo, RN · Aug 6, 2007

Yes, this is an imperfect system that we have here, but not as bad as some people would have you believe.
How is it that Germany (or any other country) has free medical care? Oh, the government is paying for it. And just where did the government get the money to pay for it. The taxpayer. Well, I don't want my taxes to be any higher than they are now. In fact, I think I'm paying way to much as it is.
Hi,
Just wanted to clarify, Germany does not have free or government paid healthcare, we do have mandatory health insurance which is like in the USA blue Shield/ Blue Cross, only everybody has it!
Just FYI
If everybody has mandatory health insurance, who pays for the unemployed?

mmutk, BSN, RN, EMT-I · Aug 6, 2007

We hit them up for a co-pay after each visit, if they can't

or won't pay we just "bill them"

MrChicagoRN, RN · Aug 6, 2007

I was brought to the ER after an auto accident.

The billing person came to my gurney and asked for demographics and for the co-pay. The other driver was clearly at fault, and they don't bill 3rd party insurance comapanies.

"I'm not prepared to pay today (even though I could easily do so), bill me."

That was the end of it.

mamalle · Aug 7, 2007

our registars can come in after the patient is evaluated by the er doctor. They will ask them for their copayment or tell them how much their bill is so far and can you pay any of that today?

PALMTREETRAVELER · Aug 9, 2007

This is a big problem at our hospital too. Over half of the patients are frequent fliers and no telling what the bill is on all of their er visits. Mngmt is cracking down on nursing staff to make sure the pt sees registration as they walk out of the door. Most of us don't personally walk people to the door and are trying to think of better ways for this to be done. such as registration hand the pt the dc instructions/scripts, them going to the room at time of discharge or when waiting to get results of tests...so far there has been little effort by the registration clerks to do this....

Altra, BSN, RN · Aug 9, 2007

Had a patient earlier this week, 23-year old, graduated from college in May, not yet employed and therefore uninsured. Accompanied to ER by his mother. His complaint was legit, although not an emergency.

He & his mother asked several times "how should we handle" getting his Rx filled? I named a few 24-hour pharmacies within a short distance. No, their issue was not access ... but a belief that because he was uninsured, we should provide the supply of abx at discharge. Umm, no.

Also advised that if s/s worsened or he developed xyz s/s he should probably return to the ER.

"If I have to do that, will it be included with today?" Umm, no. It's a whole new ER visit.

Provided referral to obtain new PCP. "But he's uninsured." Umm, well, if you need medical care, even if you're paying for an office visit out of pocket, it's a whole lot cheaper than paying for an ER visit.

"You mean we'll have to pay for this?" They were truly shocked. And understand - the issue was not ability to pay ... but a sense of entitlement.

Discharged, directed to discharge clerk, who hit them up for payment.