Emergency Cash

Emergency room visits are traumatic enough, now you'll need cash if you want treatment. Hospitals are losing money on emergency room patients and in an effort to stop the bleeding, in a manner of speaking, they are demanding cash payments up front from ER abusers.            

Last year, about 80,000 emergency room patients at hospitals owned by HCA, the nation's largest for-profit hospital chain, left without treatment after being told they would have to first pay $150 because they did not have a true emergency.

Led by the Nashville-based HCA, a growing number of hospitals have implemented the pay-first policy in an effort to divert patients with routine illnesses from the ER after they undergo a federally required screening. 

Kaiser Health News, "Hospitals demand up front payment from emergency room patients"

Patients who visit the ER are triaged as required by EMTALA rules. If they are truly experiencing a life or death emergency, or are in severe, debilitating pain, they are admitted to the emergency room and treated accordingly.

But if they are using the emergency room for a routine exam and treatment they are expected to make an up front cash payment before treatment.

Hospital officials say the upfront payments are a response to mounting bad debt caused by the surge in uninsured and underinsured patients and to reduced reimbursements by some private and government insurers for patients who use the emergency room for routine care.

In the past year, for instance, Iowa, Tennessee and Washington state reduced or eliminated Medicaid reimbursements for those visiting ERs for specified non-urgent conditions, such as sore throats or warts.

Of course in 2014 under Obamacare the uninsured issue will no longer be a problem.

Of more than 6 million emergency room visits to HCA hospitals last year, 314,000, or about 5 percent, were determined not to be emergencies, Fishbough said. About 230,000 of those patients paid and remained in the emergency room for treatment. The other 80,000 or so left. The HCA payment policy excludes children 5 and younger, pregnant women and those 65 and older.

This seems fair to me.

"These policies are beneficial because they help patients understand their financial responsibilities and make informed decisions about where to utilize services," said Tomi Galin, a spokeswoman for Community Health Systems. "These practices help reduce costs for both the patient and the hospital."

Personal responsibility. What a novel idea.

In December, Skaggs Regional Medical Center in Branson, Mo., began asking emergency room patients to pay $40 or their insurance co-payment before receiving a prescription.

"If they don't pay . . . they won't be given their prescription," hospital spokeswoman Michelle Leroux said.

The strategy is designed to help the hospital deal with spiraling, unpaid ER bills. About a third of the 120 patients treated daily in the hospital's ER are uninsured. The change was implemented after the emergency room reported $1.3 million in bad debt for August.

"This amount of bad debt is unsustainable for our operation," Skaggs chief executive William Mahoney said.

Unpaid emergency room bills impact all of us. When freeloaders skate on their bills the hospitals must raise their prices which result in health insurance carriers raising premiums.