Wednesday, March 14, 2012

Sierra Memorial Hospital, and EMTALA,

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EMTALA is a real problem, for those of us who pay for our health insurance, and have the wherewithal to pay for all "extras."

What is EMTALA?

Basically speaking, ER is not allowed to do anything that would make you think twice about getting care, like reminding you that certain costs that most people would think are part of ER, are not.

Thus if you call your insurance provider, and ask the simple question, "is ER covered at Sierra Memorial Hospital as an 'in network provider' (cheapest possible cost to insured consumer) ? "  you may get a simple answer, "YES!"  However much common sense would tell you that, that would mean that everything that is needed to make an ER worthwhile, is included, this is not the case.  Let's see how this works locally:

Sierra Memorial Hospital ER is covered for ER according to our United Health Services rep. Go there, and you are nicely processed, and if you asked about cost, they say it will all be explained in the end. Now comes the big Federally mandated switch. you go off to xray for what ever. Then they move you to a waiting room marked Urgent Care. On the wall just before you go off to see the doctor is a cute sign that blends in well with the decor that basically states that all the doctor here are “independent contractors. Guess what? You been transitioned from the ER to a zone in which everybody is out of network for independent health care, and you are about to get charged with full boat rates for everything. The Federal law probably might even prevent that sign as well, but since that clinic is marked "Urgent Care," and might possibly get referrals from elsewhere other than ER, it is probably legal.That xray tech? Possibly also out of network, but Sierra Memorial has just assured me that most likely they are in network.. She gives a preliminary reading which the doctor seeing you uses to go forward.  Guess what ? Next they might even send that xray out to be read by a full attending doctor, also possibly out of network.  At Sierra Memorial, regardless of how many radioogists look at it, just one charge, and most likely in network. And then recommend that you have followup xrays to see if any cracks develop later on. This situation needs to be posted in the first waiting room.

And by law, it cannot. EMTALA RULES!

And what, mighten you ask is EMTALA?

from Wikipedia. see for a whole lot more information:

Hospital obligations

Hospitals have three obligations under EMTALA:
  1. Individuals requesting emergency care, or those for whom a representative has made a request if the patient is unable, must receive a medical screening examination to determine whether an emergency medical condition (EMC) exists. The participating hospital cannot delay examination and treatment to inquire about methods of payment or insurance coverage, or a patient's citizenship or legal status. The hospital may only start the process of payment inquiry and billing once they have stabilized the patient to a degree that the process will not interfere with or otherwise compromise patient care.
  2. The emergency room (or other better equipped units within the hospital) must treat an individual with an EMC until the condition is resolved or stabilized and the patient is able to provide self-care following discharge, or if unable, can receive needed continual care. Inpatient care provided must be at an equal level for all patients, regardless of ability to pay. Hospitals may not discharge a patient prior to stabilization if the patient's insurance is canceled or otherwise discontinues payment during course of stay.
  3. If the hospital does not have the capability to treat the condition, the hospital must make an "appropriate" transfer of the patient to another hospital with such capability. This includes a long-term care or rehabilitation facilities for patients unable to provide self-care. Hospitals with specialized capabilities must accept such transfers and may not discharge a patient until the condition is resolved and the patient is able to provide self-care or is transferred to another facility.

Here is a site that discusses what doctors can and can't dicuss, in detail,

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