Welcome to the
Center for Health Insurance Claims Advocacy
a non-profit corporation
We are Experts in Unfair Claims Settlement Practices Violations
IN THE NEWS "a excellent guide to provider and patients rights"
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Welcome to the Center for Health Insurance Claims Advocacy a non-profit corporation We are Experts in Unfair Claims Settlement Practices Violations
IN THE NEWS "a excellent guide to provider and patients rights"
|
|
Arizona Unfair Health Insurance Claims Information California Unfair Health Insurance Claims Information How to File a Claim for Your Benefits under ERISA A Consumer's Guide to Health Care Appeals
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Emergency care: Know your rightsGet a Copy of Arizona's Unfair Claims Settlement Practices Act When you're injured and in the emergency room, the last thing you want to do is fight for treatment. Fortunately, a federal law passed in 1986 to prohibit a practice commonly known as "patient dumping" gives you the right to emergency care regardless of your ability to pay. The federal law applies to hospitals that participate in Medicare — and that's most hospitals in the United States. 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 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 will sometimes 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 informed consent. What you're not entitled toIf you're not having an emergency, and you don't have the
ability to pay, the hospital emergency room does not have to treat you. The
hospital will most likely direct you to your own doctor or to a community health
clinic. The patient-dumping law was passed to ensure people in distress get necessary medical attention. The question of payment; however, is between you and your insurance company. If you don't have health insurance, then you will still 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. According to the U.S. Department of Health and Human Services, 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. The consumer watchdog group, Public Citizen, claims despite the law some hospitals kept refusing to provide basic treatment for patients unable to pay for it. "It’s distressing that this law has been in place, and hospitals are still flouting it," said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. "The government needs to do more to force hospitals to comply. People shouldn’t be denied desperately needed emergency medical care when they go to a hospital." Public Citizen released a report, which claims more than 500 hospitals were cited for illegally sending patients with emergency conditions to other hospitals in the late 1990s. Rick Wade, a spokesman for the American Hospital Association, denies Public Citizen’s claim that patient dumping is a serious problem. ``We have a million visits to the [emergency room] every year,'' Wade said. ``We have 5,000 hospitals in this country. The numbers [Public Citizen] is reporting are not significant and do not reveal any sort of trend. There has never been any evidence that patient dumping is rampant.” State by state
Individual 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 might provide you with some additional ones. If you feel 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 your insurance company is unjustly denying payment, try your state's insurance department. Some states also require insurance companies to pay for emergency room care if a "prudent layperson, acting reasonably," would have considered the situation a medical emergency. Thirty-eight states and Washington, D.C., enforce a prudent layperson standard. |
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