Co-pays in the ER

  1. 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
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    About kaycee

    Joined: Mar '01; Posts: 1,898; Likes: 37


  3. 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.
  4. by   Speedy1RN
    Are your institutions receiving Medicare reimbursements? There is this thing called emtala.
  5. by   fiestynurse
    Yes, we recieve medicare reimbursements and technically we cannot refuse anyone care. But, that doesn't keep us from asking for those co-pays and calling HMOs for preauthorizations. ERs are losing tons of money here in Calfornia, and many hospitals have closed their ERs all together. Mainly because of all the increasing numbers of uninsured that are using the ERs as their primary care facility. Governor Davis just pumped some money into the ERs to help keep them afloat, but it's a temporary fix. Let's just say that this whole healthcare system is a big mess!
  6. by   ERnursie
    We don't collect in the ER(although some patients ask). It's much easier to tell them that they'll get billed, especially if they are fed up to begin with.
  7. by   CEN35
    nope that falls on the part of billing.........we don't do anything with billing. hopefully we will never have too. like we don't have enough things to do already?
  8. by   canoehead
    I LOVE the idea of copays!! We must triage before insurance info so I imagine the idea of triaging and then asking for a copay for nonurgent cases would be legal, and weed out the 2am runny noses. Whether it would be financially a plus is up for debate as the PR would stink.
  9. by   spudflake
    At our facility the admit clerks ask for the co-pay or down payment AFTER the doctor has seen the patient. That's the first time we can legally ask. If the triage nurse has MSE ability then a co-pay can be asked for at registration. If the patient says no - they're still seen regardless - even the 2am runny noses
  10. by   LtlBit RN-ER
    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!
  11. by   NinaC
    In our hospital, we are not allowed to discuss insurance....also nurses must triage the patient first and then the admissions clerk goes and registers them. It is an emtala violation if they are asked about their ability to pay much more ask for co-pays
  12. by   kaycee
    It is not a violation if the co-pay is asked for after treatment is rendered in the ED, upon discharge. A lot of ED's are doing this and we are starting in Feb.
  13. by   debbyed
    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.
  14. by   kaycee

    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.