Patients who carry no health insurance

[AprilPretty07]

I would like to know why is it that when a patient who happens to be injured whether it be the fault of another or themselves, usually will not be seen as quickly as another who may be injured who is totally insured. I sometimes think that people who fall into certain income brackets and who live off a budget should only have to pay a certain percentage each month whether they be employed or not. Do I have any here that may agree with this? :?

[JPINFV]

I would like to know why is it that when a patient who happens to be injured whether it be the fault of another or themselves, usually will not be seen as quickly as another who may be injured who is totally insured. I sometimes think that people who fall into certain income brackets and who live off a budget should only have to pay a certain percentage each month whether they be employed or not. Do I have any here that may agree with this? :?

As long as any payment plans are mutually agreed upon between the customer and provider [healthcare IS a business after all], then I have no problem with it. As far as wait time, I think that there might be a little observer bias. The ER isn't a first come, first serve place. When you notice someone waiting, there might be a very good reason such as the emergency room not having an appropriate bed available or because of how the emergency room is set up.

For example, at one of the hospitals in the area I used to work in had a program called "Triage Plus." Essentially, they used the code room to see patient in the waiting room so that the physicians can do an exam and start running tests. While waiting for the results to come back from any lab work that was needed, the patient waited in the waiting room.

[AprilPretty07]

Thank you for your feedback!

[AnthonyM83]

As far as I know, the doctors and nurses treating the patient have no idea what their insurance status is when they first come in....but I could be wrong.

[Just Plain Ruff]

I work to help hospitals put computer systems in their facilities.

The only way to get in the ER system is to be quick regged and that asks 0 NO insurance questions. Only name, age, DOB and other non-financial identifiers.

That's all they can legally ask you until a nurse or a physician provides you with the appropriate medical screening. Until then, you cannot be asked your insurance or payment status.

So to not see someone on basis of insurance or to put the uninsured at the back of the line is probably not gonna happen. If it does it's a violation that will cost the hospital bunches.

[AnthonyM83]

I work to help hospitals put computer systems in their facilities.

The only way to get in the ER system is to be quick regged and that asks 0 NO insurance questions. Only name, age, DOB and other non-financial identifiers.

That's all they can legally ask you until a nurse or a physician provides you with the appropriate medical screening. Until then, you cannot be asked your insurance or payment status.

So to not see someone on basis of insurance or to put the uninsured at the back of the line is probably not gonna happen. If it does it's a violation that will cost the hospital bunches.

What's it a violation of? I ask because pretty much every single ER I've taken patients to has a triage nurse and registration clerk almost concurrently ask for their personal info (including insurance)...at the busy hospitals registration usually gets to them first while they wait to be triaged.

[VentMedic]

EMTALA/COBRA

. THOU SHALL NOT: Delay the MSE in order to obtain financial information nor induce the patient to leave without MSE by drawing payor issues or financial demands to the attention of patient or family prior to the completion of the MSE and initiation of stabilizing care. Care may not be denied based on denial of pre-authorization. Financial questions, documents, and pre-authorization is at your own peril.

[Just Plain Ruff]

EMTALA/COBRA

. THOU SHALL NOT: Delay the MSE in order to obtain financial information nor induce the patient to leave without MSE by drawing payor issues or financial demands to the attention of patient or family prior to the completion of the MSE and initiation of stabilizing care. Care may not be denied based on denial of pre-authorization. Financial questions, documents, and pre-authorization is at your own peril.

to paraphrase that govspeak

If you ask financial information prior to a qualified medical person getting a quick triage on you then the hospital is in trouble. You can only ask non financial info to get them into the system. If you ask for insurance before the nurse or doc sees you then that's a NO NO.

if I remember right the fines are I think 50K but they might be less or might be more but thats the number i remember.

The registration desk can be as close as they want to be to the triage nurse but they can't get insurance info until you are triaged. The exception is Fred and Ethel go to the ER. Fred is having chest pain. Fred gets triaged into the system while Ethel gives financial information to the clerk. If you do it that way then it's not a bad thing, just make sure that the triage exam is being done or started prior to asking of any insurance questions. What they are trying not to have happen is for the insurance information to make any impact on the treatment order of the patients.

so you can collect triage info and also collect insurance info at the same time but the insurance info has to be gotten apart from the triage info.

[AnthonyM83]

EMTALA/COBRA

. THOU SHALL NOT: Delay the MSE in order to obtain financial information nor induce the patient to leave without MSE by drawing payor issues or financial demands to the attention of patient or family prior to the completion of the MSE and initiation of stabilizing care. Care may not be denied based on denial of pre-authorization. Financial questions, documents, and pre-authorization is at your own peril.

Is that paragraph open to interpretation or has it been specifically interpreted by EMTALA/COBRA? Because I could read that as you shall not draw payor issues or financial demands IN ORDER TO induce patient to leave.

If you simply ask NOt to induce payor to leave, aka simply handing them a form to fill out Name, DOB, Address, Religion, Insurance, Insurance Number, Emergency Contact, is that for sure a violation?

[Scaramedic]

I would like to know why is it that when a patient who happens to be injured whether it be the fault of another or themselves, usually will not be seen as quickly as another who may be injured who is totally insured.

Wrong. There is a reason hospitals have two separate areas in the waiting room, triage and billing. Triage is where the patient (unless critical) is seen by an RN and placed in an order for treatment based on chief complaint. It's a simple concept that too many civilians cannot comprehend. Chest pain before finger lac, GSW above hemorrhoids, open laceration before sprain. This is how it is decided the order patients are seen.

After triage (in most hospitals I've been around) they are THEN sent to billing. The treatment order has already been set by the time they are sent to billing. If a hospital is basing treatment on a financial basis they are breaking the law as long as they have a big EMERGENCY sign out front.