Co-pays in the ER - page 4
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... Read More
Mar 24, '02Occupation: rn - er Joined: Nov '01; Posts: 323; Likes: 147CO-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)!
Apr 12, '02Occupation: rn Joined: Nov '01; Posts: 7I'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.
Feb 18, '05Joined: Feb '05; Posts: 5It 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.
Feb 18, '05Occupation: Staff Nurse, Educator Specialty: emergency nursing-ENPC, CATN, CEN ; Joined: Jun '04; Posts: 237; Likes: 52We 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.
Feb 18, '05Occupation: ER RN > 20 yrs Joined: Sep '03; Posts: 25Correct: 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.
Feb 19, '05Joined: Jan '05; Posts: 155; Likes: 44Quote from debbyedAre 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?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.
Feb 19, '05Joined: Jan '05; Posts: 155; Likes: 44Quote from DanRnGood! 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.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.
It's simply not your problem.
Feb 19, '05Joined: Jan '05; Posts: 155; Likes: 44Obviously, 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.
Feb 19, '05Joined: Mar '01; Posts: 1,898; Likes: 37Our 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.
Feb 19, '05Occupation: emergency room nurse Joined: Jun '02; Posts: 132; Likes: 3Quote from debbyedWe 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!
Feb 19, '05Occupation: er nurse @ 2 critical access hospitals Specialty: 4 year(s) of experience in er, pediatric er ; Joined: Dec '04; Posts: 208; Likes: 11The ER I work for started collecting copays on the patient's way out. I work for a children's ED,so people are probably better about paying when it is their children's care. We really don't have that many problems with it. We have the patient's go to a exit station where registration collects the money.
Feb 19, '05Occupation: RN Radiology Specials Lab, and ER Joined: Jan '03; Posts: 117; Likes: 29I have mixed feelings regarding co pays in the ER. Part of me would love to see them considering the fact that many of the cases that shouldn't be in the ER wouldn't be if THEY had to pay for their care. Think about the people on Medicaid that never have to pay a cent for their care. I hate to sound mean, but if they would have to pay a $5-$10 co pay many of them would not use the ER like they do. I'm talking about the people that come to the ER for things I wouldn't even see my family Dr for. Had one woman call the squad for a superficial cut on her hand. Would she have done that if she had to pay for it? The part of me that don't like the idea is the hassle it would create for our poor registration people.
Feb 20, '05Occupation: Physician Assistant Joined: Jan '04; Posts: 97; Likes: 12Has anyone looked at a typical ER bill lately? It makes me feel guilty.
The ones I really feel sorry for are the ones who can only afford to send in $20 per month, but never miss a payment. They get a $700 bill for suturing a minor lac, and you just feel like you are adding to their poverty. I am talking about the honest, hard-working, responsible ones who are poor but have the character to resolve their debts. They make a real effort, and the $20 may be a lot of money for them.