Imagine that you're hiking, fall, and break your leg. A friend gets you to the nearest hospital, where you're told you'll need to cough up your insurance deductible before X-rays are taken. Unfortunately, you're on a high-deductible insurance plan and don't have an extra $3,000. Is what the hospital doing legal? Do you have any recourse? Here, we dig into these questions.
A nation without universal healthcare
There are 195 countries on this planet and 152 offer free or universal healthcare to at least 90% of their citizens. The United States does not. In fact, the U.S. is the only country in the developed world without a universal healthcare system. We join countries like Iran, Pakistan, Yemen, and Nigeria in allowing the uninsured sick to fend for themselves.
What does a lack of universal healthcare have to do with hospitals demanding prepayment? According to Very Well Health, between the uninsured, underinsured, and the number of people living without enough savings to cover such an emergency, hospitals "know after the procedure is completed, people may not pay what they owe."
So what happens to the roughly 30 million Americans who are uninsured when they are injured or ill? What about the 56% of Americans who say they don't have enough money saved to cover a $1,000 emergency and cannot make a large upfront payment before receiving care? Are U.S. hospitals required to treat them when they show up in the emergency room?
The answer is both "yes" and "no."
EMTALA
A federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA) requires almost all hospitals to provide emergency medical treatment, regardless of whether the patient has health insurance.
EMTALA applies to all hospitals that:
- Have an emergency department
- Accept Medicare payments from the federal government
According to All Law, nearly every hospital in the U.S. meets both of these requirements, meaning they should all provide emergency medical care, no matter what. Can't produce an insurance card or pay a medical bill upfront? They should still offer stabilizing treatment.
You don't even have to make it into the emergency room. EMTALA states that you should receive emergency treatment as long as you're on hospital property and within 250 yards of the main hospital building.
Two reasons hospitals should not request upfront payment
Any medical facility without an emergency room (like your doctor's office) can request payment upfront. However, there are two primary reasons your local hospital probably cannot deny care:
- The contracts signed by insurance providers and medical providers normally prohibit medical providers from requiring payment before medical services are provided, reports Very Well Health.
- Per the American College of Emergency Physicians (ACEP), emergency departments are unique, and anyone with an emergency must be treated or stabilized, regardless of their ability to pay.
Hospitals know the rules, but that doesn't mean all follow them.
Exceptions to the rule
While the EMTALA makes it clear that hospitals must treat or stabilize anyone who comes to them with an emergency, there are exceptions to the rule.
Here are the scenarios under which a hospital can refuse to admit or treat a patient:
- When it's a non-emergency case and the patient does not have health insurance.
- When the hospital is short on resources. For example, a hospital that is short-staffed, needs more medical supplies, is overcrowded, or needs more beds can look for another hospital to treat the patient.
- When a hospital believes a patient would receive better treatment at a different hospital. For example, if a heart transplant patient comes into the E.R. exhibiting signs of organ rejection, a small hospital may seek a larger facility with transplant surgeons on staff.
- When a hospital does not have the medical personnel or equipment required to properly treat a patient.
Under no circ*mstances can a hospital deny treatment based on age, sex, or religious affiliation.
The bottom line is this: While hospitals are required by law to provide care to all patients suffering from a medical emergency, there are circ*mstances under which they are permitted to deny service. However, you're unlikely to know that until you're at the hospital.
No matter what your financial situation is or whether you have health insurance, you should always seek medical attention when you need it. There's no reason to risk your life over fear that you may not be treated. If your condition is serious, hospitals must stabilize you and/or find another hospital to continue your treatment. Hospitals can be legally liable for injury or death resulting from failure to treat or admit you.
FAQs
Federal law requires most U.S. hospitals to treat or stabilize a person with an emergency health concern, even if they can't pay for treatment. Under certain circ*mstances, a hospital can refuse treatment. Despite the law in place, it has become increasingly common for a hospital to require payment upfront.
Why do hospitals want patients to pay upfront? ›
According to hospitals, knowing the costs of services ahead of time can provide patients with an opportunity to comparison shop and avoid facing a large, unexpected bill.
Can a patient be banned from a hospital? ›
As a guest, it is entirely possible to be banned, either at the request of a patient, medical staff, or security personnel, it is entirely possible. As an emergency patient, staff can request a law enforcement or security person's presence.
Is it OK to refuse medical treatment? ›
A mentally competent adult has the legal right to refuse medical treatment even if causes them serious illness or death. This is sometimes the case with a terminal illness in which a person will opt for a higher quality of life over a longer quantity of life.
What rules apply when the patient needs to be admitted to the hospital? ›
Except in the case of emergency admissions when the patient is unable to provide information, all patients must go through a registration process before being admitted to the hospital. This process enables hospital staff to collect a patient's medical history and personal information to better coordinate care.
Can a hospital force me to pay a certain amount? ›
But there is no law for a minimum monthly payment on medical bills. If that were true, hardly anyone would need to file bankruptcy for medical debts. The truth is that the medical provider can sue or turn you over to collections if they are not satisfied with the amount that you are sending in.
Should you ever prepay a hospital bill? ›
Doctors want to be sure that they will be compensated for the care they provide. Fourth lesson: It is not illegal to be asked to pay what you may owe in advance for a major medical event. But if you are asked to pay upfront, legally you don't have to.
Can a hospital refuse to treat a patient in the US? ›
Being refused treatment while seeking immediate medical attention is every patient's worst nightmare. If you're sick, injured, or hurt, can a healthcare organization, like a private doctor, hospital, or family doctor's office, refuse to treat you, even when you have health insurance? The answer, unfortunately, is yes.
Can a patient be forced to accept treatment? ›
You have the right to refuse medical treatment or treatment with medications (except in an emergency) unless a capacity hearing is held and a hearing officer or a judge finds that you do not have the capacity to consent to or refuse treatment. The advocate or public defender can assist you with this matter.
Can a hospital blacklist a patient? ›
Patients might experience blacklisting in the medical field, particularly those who have been seeking attention for a lengthy medical problem. Some doctors may not return phone calls or may refuse to see a patient because of the patient's history.
When Patients Refuse Treatment
- Patient Education, Understanding, and Informed Consent. ...
- Explore Reasons Behind Refusal. ...
- Involve Family Members and Caregivers. ...
- Document Your Actions. ...
- Keep the Door Open.
at 331 (Stevens, J., dissenting) ( [A] competent individual's decision to refuse life-sustaining medical procedures is an aspect of liberty protected by the Due Process Clause of the Fourteenth Amendment. ).
What is it called when a patient refuses treatment? ›
Informed refusal is where a person has refused a recommended medical treatment based upon an understanding of the facts and implications of not following the treatment. Informed refusal is linked to the informed consent process, as a patient has a right to consent, but also may choose to refuse.
What is the golden rule in hospital? ›
We need to remember and implement the Golden Rule-treat each patient as we would like to be treated-by taking a moment to ask, "How are you feeling?" and then listen well.
What are inpatient criteria? ›
Generally, a patient is considered an inpatient if formally admitted as inpatient with the expectation that he or she will remain at least overnight and occupy a bed even though it later develops that the patient can be discharged or transferred to another hospital and not actually use a hospital bed overnight.
Is it normal to pay for surgery up front? ›
Depending on a patient's health plan, credit history, medical needs, and choice of hospital, the patient may be asked to pay some or all of their deductible upfront, before receiving medical care.
Does surgery have to be paid upfront? ›
Hospitals are becoming more aggressive about asking patients with health insurance to pay their share of the tab up front. In most cases, consumers can't be required to pay up front. And as the above example shows, it's usually better to wait to see how much of the bill is covered by your insurance plan.
What does upfront healthcare do? ›
Our patient engagement platform eliminates technology fragmentation to guide patients to necessary care through proactive, clear, and highly personalized omnichannel communication — empowering patients to take charge of their health.
Do you pay copay before or after a visit? ›
Copayment (Copay)
After you pay your deductible, then you pay your copay for your ER visit. The copay is the set dollar amount you pay for covered services after you meet any applicable deductible.
