Federal law gives you the right to emergency care, regardless of your ability to pay. Here are the details on how you should be handled at the hospital.
What you're entitled toIn a nutshell, the federal patient-dumping law entitles you to three things: screening, emergency care and appropriate transfers. A hospital must provide "stabilizing care" for a patient with an emergency medical condition. The hospital must screen for the emergency and provide the care without inquiring about your ability to pay.
Hospitals cannot transfer patients until their condition has been stabilized. There are a couple of exceptions: if a patient requests to be transferred and is fully informed of the consequences of being moved, or if a physician feels that the medical benefits exceed the risk of the transfer
For instance, if a hospital is not equipped to deal with a trauma case, the emergency room physician may transfer the patient to a hospital that has a trauma center. Patients themselves sometimes will want to go to another hospital, either because they prefer that hospital or because their doctor is there. If you ask to be transferred to another hospital before your condition is stable, you'll most likely have to sign a form to show you've given your informed consent.
What you're not entitled toIf you're not having an emergency, then the hospital emergency room does not have to treat you. The hospital most likely will direct you to your own doctor or to a less-intensive-care setting, such as a community health clinic.
The patient-dumping law was passed to make sure that people in distress get the necessary medical attention. The question of payment, however, is between you and your insurance company. If you don't have health insurance, then you still will have to make payment arrangements with the hospital.
Once your condition has stabilized, the hospital also has the option of moving you to another facility.
The Department of Health and Human Services says that the patient-dumping law also applies to HMOs that illegally demand pre-authorization for emergency room visits. Emergency room care cannot be delayed while a hospital tries to obtain pre-authorization.
State by stateIndividual state regulations also have a bearing on the way you're treated in an emergency room, and upon your health insurer's decision to pay for that treatment.
The federal law allows you basic rights, and your state laws may provide you with some additional rights. If you feel that you have been treated unfairly, either by the hospital or by your insurance company, try calling your state's department of health. If you feel that your insurance company is unjustly denying payment, try your state's insurance department.
Some states also have a regulation that requires insurance companies to pay for emergency room care if a "prudent layperson, acting reasonably," would have considered the situation a medical emergency.
What is considered an emergency situation?According to the Emergency Medical Treatment and Labor Act (EMTALA), an emergency medical condition means:
(A) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:
|placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy|
|serious impairment to bodily functions, or|
|serious dysfunction of any bodily organ or part; or|
(B) with respect to a pregnant woman who is having contractions:
|that there is inadequate time to make a safe transfer to another hospital before delivery, or|
|that transfer may pose a threat to the health or safety of the woman or the unborn child.|
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