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.
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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? ›
However, forcing patients to pay in advance also relieves companies from the cost of having to track and bill patients later on. This shift comes as insurers, hospital systems, and private equity firms are quietly but efficiently buying up medical practices across the country, Business Insider previously reported.
Can a doctor refuse to treat a patient who owes money? ›
Ability to Pay
Some medical providers may consider refusing to treat because of the patient's inability to pay for treatment. Generally, in non-emergency situations, this is allowed. A private internist, for example, might refuse to schedule a patient's appointment if that patient has unpaid medical bills.
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 happens if you don't have money for the hospital? ›
Contact the billing department and explain that you have a financial hardship and can't pay your medical bills. Often, you get a discount just by asking, and many hospitals have hardship programs that offer financial assistance.
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.
What does upfront healthcare do? ›
Upfront removes access barriers by combining powerful consumer insights with machine learning to create highly-personalized patient communications, activating patients across the continuum of care.
Can a patient be refused treatment due to ability to pay for service? ›
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.
Is refusing to treat a patient illegal? ›
EMTALA provisions do not apply to private doctors. These providers have the right to refuse care to patients for almost any reason, including the inability to pay. Doctors are prohibited from refusing treatment only if their decision is based on some form of illegal discrimination.
What do doctors do if you don't pay? ›
Typically, outstanding healthcare bills end up in collections. As mentioned before, a collection can turn into a lawsuit or lead to bankruptcy. Paying medical debt not only gives you peace of mind, but will also keep negative items off your credit report.
- Right to Be Treated With Respect.
- Right to Emergency Care.
- Right to Obtain Your Medical Records.
- Right to Privacy of Your Medical Records.
- Right to Informed Consent.
- Right to Refuse Treatment.
- Right to Refuse to Take Part in Research.
- Right to Receive and Question Itemized Bills for Medical Services.
Understand their story Try to understand the patient/family's story before you try to change their mind. This means to suspend your attitude toward their decision and, as openly and non-judgmentally as possible, understand the reasons for their decision.
Is there a constitutional right to refuse medical treatment? ›
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. ).
Can medical debt be forgiven? ›
Forgiving debt for health
To address this public health crisis, state and local governments are partnering with debt cancellation organizations like RIP Medical Debt, who take donor money to purchase medical debt from providers and collection agencies at a steep discount and forgive it.
What happens if you are ill in the USA without insurance? ›
If you have a health situation that qualifies as an emergency, hospitals and emergency rooms must provide care to you regardless of whether or not you have health insurance. That doesn't mean you will receive the services for free. You will be responsible for the bill, which can become quite expensive.
Is emergency care free in the USA? ›
You'll be charged afterwards, whether you can pay or not. The Emergency Medical Treatment and Labor Act (EMTALA), a federal law passed in 1986, requires anyone coming to a hospital emergency room to be stabilized and treated, regardless of their insurance status or ability to pay.
Should you ever prepay a hospital bill? ›
If you're asked to prepay for medical care, here's how you should handle it: Know you can say no. Waiting until you get the bill is in fact what insurance companies typically advise, says Brousse. While hospitals use sophisticated software to estimate your portion of the bill, they don't always get it right.
Why are upfront collections important to the practice? ›
The upfront payment is important for practices because it provides more money inflow. The payment is received directly and not through the complicated billing procedure or credit and debit card.
What is the difference between prepay and copay? ›
Copays can be collected from Patient Accounts and Calendar. Here are some knowledge base articles to show you how to collect copays. Prepayments are used when the patient pays more than what is owed. Perhaps the patient wants to pay for a series of appointments ahead of the sessions.
Why am I being charged more than my copay? ›
You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network. “Out-of-network” means providers and facilities that haven't signed a contract with your health plan to provide services.
