Can a hospital emergency room delay or refuse treatment, to talk about insurance or money?

Many hospitals all over America have started experimenting with requiring pre-payment for health care. Some hospitals are providing a cost estimate along with pre-surgery hospital advice. I, for one, like that idea, but wonder how far hospitals will take this.

Hospitals are feeling a cash crunch that they blame on an unforeseen consequence of Affordable Care Act (Obamacare) insurance plans. 

Virtually everyone has seen health insurance premiums skyrocket over the past several years. To try to save money and survive financially, lots of people have chosen high-deductible plans that require them to pay $5,000, $10,000, or more out-of-pocket before the insurance company pays a dime.

It is not surprising that many of these well-intentioned consumers end up being short of cash to pay their huge out-of-pocket portion when they need to go to the hospital. According to the Kaiser Family Foundation, 45 percent of Americans felt that it would be difficult for them to pay an unexpected $500 medical bill. But even work is the sticker shock they feel after the first time they go to the hospital and get a bill.

What are the limits to what a hospital can charge?

I have no doubt that the financial strain that high-deductible plans place on families also impacts the hospitals’ bottom line.

On the other hand, I also wonder who is actually coming up with the sky-high prices that hospitals try to charge their patients. And do they think that anyone in America could actually afford to pay them?

I recently looked at a United Healthcare evidence of coverage statement for someone who had a laparoscopic gallbladder surgery at Houston Methodist Willowbrook Hospital in early 2017. The hospital billed over $40,000 for a hospital stay that lasted less than 48 hours, and the whole operating room time was a whopping 20 minutes or so. Bear in mind, that staggering amount does not include any physician charges. Thankfully, this person’s United Healthcare insurance applied a contractual reduction that brought the bill down from $40,000 to less than $5,000. Reading that brought one word to my mind: Cuckoo!

When people become aware of bills like that and have high deductibles, some will just avoid getting the healthcare that they need in the first place. Others will go ahead and get the care, and then avoid paying their out-of-pocket portion because they just cannot afford it.

According to a recent Reuters article, Mark Heubner, director of Health Services Financing at Commerce Bank, as saying, “People are more likely to pay a bank than a hospital. People are aware that banks will come after them. Banks do collect on debt, and hospitals generally have been more relaxed.”

In Houston, though, some hospitals have not been so relaxed and, surprisingly, they have filed lawsuits to collect astronomical, undiscounted charges from patients—and, in particular, those who are uninsured. For example, take Memorial Hermann Healthcare System, the largest nonprofit hospital system in Texas. Memorial Hermann Hospital sued an uninsured man to collect over $456,000. I stepped in to represent him, and we fought back.

So, to my question: Is there a limit to what hospitals can charge? Well, there does not seem to be any reasonable limit. But there are some things that you can do to fight back.

First, whether you have insurance or not, check your hospital bills thoroughly. If there are any discrepancies or errors—and there often are—contact the billing office and dispute them.

In my years of practice as a Texas medical malpractice lawyer, I have seen that common hospital billing mistakes include things like charges for medications and equipment that were never provided. This can often happen when medications were ordered by the doctor to be given on a schedule, but the patient is discharged before they were actually provided. These kinds of bad charges can really add up.

Second, if you are facing a bill that you cannot pay, check with the hospital administration to see if there is a way to have a substantial portion of the bill written off as charity care. Some hospitals will do this, but there is an application process and you will have to prove your inability to pay. It is certainly worth trying.

Third, if you get sued by a hospital over a bill or it gets into an aggressive collection mode, do not ignore it. Hire an attorney to represent you and challenge the reasonableness of the bills. Yes, there is a cost associated with it, but the likely benefit to you would far outweigh that cost. There are some good defenses available to you. A defense that I successfully used in a case where my uninsured client was sued for a huge bill is that the hospital’s charges were unconscionable. In other words, why should the hospital be able to collect such an obscene amount from my client when no one ever pays those inflated charges?

Can the hospital deny me care in the emergency room?

As hospitals start focusing on payment arrangements up front and even requiring pre-payment for healthcare, it makes me wonder about what will happen when it comes to emergency care.

After all, the tension for hospitals between getting paid and providing health care is not new. In the 1980s, there was a crisis of what was called “patient dumping.” If you showed up an emergency room and did not have insurance or money to pay, you were dumped, or told to leave, without treatment.

In 1986, in response to this major problem, Congress passed, and President Ronald Reagan signed into law, the Emergency Medical Treatment and Active Labor Act (EMTALA).

In short, EMTALA protects public access to emergency healthcare services without regard to a person’s ability pay. Whether you have health insurance or not, it is important to know you rights under this game-changing law.

EMTALA is triggered when a person walks into a hospital emergency room requesting treatment for an emergency medical condition or active labor.

The law defines an emergency medical condition as an acute condition where the symptoms (including pain) are severe enough that without medical attention it would be reasonably expected that the person’s (or unborn’s child) health would be put in jeopardy. In other words, a lack of treatment could cause death or serious impairment of any body part or function.

When someone has an emergency medical condition or is in active labor, EMTALA requires that the hospital emergency room provide an appropriate screening, within its capabilities. If the screening reveals a bona fide emergency medical condition or that the patient is in active labor, EMTALA requires the emergency providers to stabilize the patient before discharge or transfer to another facility.

For an emergency medical condition, EMTALA defines stabilizing the patient as no material deterioration of the patient's condition is likely to result from discharge or transfer to another facility. When it comes to a patient in active labor, stabilizing means delivery of the baby and placenta.

The law allows the hospital to ask about health insurance or the ability to pay, but does not allow any delay whatsoever in terms of examination treatment in order to make that inquiry.

All of these requirements under federal law are placed on hospitals if they participate in the Medicare program.

We are here to help

If you or someone you care for has been a victim of patient dumping because you could not pay the bill, or have been injured because of medical malpractice in a hospital setting, call 281-580-8800 for a free consultation with the experienced Texas medical negligence lawyers at Painter Law Firm.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.