Uninsured and Ers, Someone Please Explain.

This is an excerpt from the Tribune Washington Bureau:

At MedStar Washington Hospital Center, a sprawling medical campus three miles from the U.S. Capitol, the emergency department sees its daily share of uninsured patients seeking care for everything from heart attacks to insect bites. Last month, more than 400 of 8,400 seen lacked coverage, according to hospital figures. Nationwide, the uninsured account for nearly a fifth of emergency department visits.

In nearly every case at MedStar, doctors and nurses never know who pays the bills. “It doesn’t enter the equation,” said the hospital’s emergency chief, Dr. Bill Frohna.

But the bills come due. And although emergency care accounts for a small fraction of total health care spending, many hospitals are feeling increasingly strained by the free care they provide.

Last year, MedStar Washington reported delivering $107.2 million in care for which it was not reimbursed. Nationwide, the total amount of uncompensated care provided to the uninsured reached an estimated $56 billion in 2008, according to one study.

Those costs have prompted financially strapped hospitals to rely on a complex system of shifting costs. Most of the burden falls on taxpayers, with the government providing tens of billions of dollars annually to help hospitals care for the uninsured. Privately insured Americans also pay a price as insurers raise premiums to reflect higher charges from hospitals.

In the past, the cost shifting was cited by many conservatives as a reason why the federal government should require Americans to have health insurance.

“If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance,” the Heritage Foundation’s Stuart Butler said in 1989. “We will not deny him services — even if that means more prudent citizens end up paying the tab.” Butler, like many Republicans, has since renounced the insurance mandate.

*I don't know if that helps but I wanted to supply an investigative report instead of personal opinion.

Each hospital has their own fund, some are better funded. Most people don't know about that so they would like to believe that we, the insured, pay for unpaid bills. Not really, write offs tend to come out of profits. I work for a group that has no funds, we write off what we know we cannot collect rather than destroy people's credit. We will also take ten dollars a month for the rest of your life.

What the insured pay for is the gap in what the government pays on Medicaid and actual costs. I would imagine that just got a whole lot bigger.

If you went to a doctors office without insurance they could turn you away-an ER is not permitted to. You will still be billed but many do not pay. And when they go again they are still not allowed to be turned away so they get their treatment and again toss the bills.

In SOME states (not all) ER trips are free if and only if you don't have insurance.

In states where this doesnt exist many people give phony names and addresses. Hospitals expect this and it's in their budget. NOT that it's okay, meaning that other things cost more because of x million that they budget for no name ER visits.

ERs CAN AND DO turn people away.

The ONLY ERs required to take anyone regardless of their ability to pay are 'County' hospitals. They're federally funded. They have huge waiting times (hours or even days for non life threatening emergencies), and are also usually the local trauma centers. That they are required by law to take everyone does not mean they won't bill you (or attempt to), and send you to collections. It PURELY means that they won't send you away if you don't have an insurance card or credit card.

Most hospitals are private. Many USED to be 'community hospitals', but those mostly went bankrupt and were bought by insurance companies. ANY private hospital can refuse treatment. I was fortunate enough to work in a community hospital (sand rules as a county hospital, they take everyone), and we got a LOT of people who'd been sent away from private hospital ERs, and a LOT of people died (bad outcome in hospital speak) who WOULDN'T have if the private hospital (group health, eyc) had at least stopped their freakin bleeding when they'd gone there first!!!!

As an aside, I was up north fishing when my then boyfriend got stung by a dogfish. Argh. So we went to Valley Hospital in Monroe WA (effers). We had insurance, so we were fine. But while boyfriend was being treated a migrant came in HOLDING HIS FOOT. He was turned away. Myself and another patient (off duty cop) caught up to him in the parking lot. I did a tourniquet on his leg (which he wouldn't have lost if I hadn't done it, but he was bleeding out), and the cop got us to County Hospital ALMOST 2 HOURS AWAY.

He lost his leg (I had to do a 'crunch' tourniquet, because he couldn't lose any more blood and cop and I didn't have fluids, much less blood or plasma!), but he lived.

***

If you read the patient rights list on the back of exam doors... You'll see privately owned hospitals reserve the right to refer you to another facility. They don't say they'll get you there, or treat you until you're stable.

Some (I don't know nationwide stats) have a policy to stabilize a patient before 'referring' them. This varies a GREAT deal, and depends a lot on the docs and nurses on duty. Dude with a bag on his stump was 'ambulatory', and Valley was being staffed by inhuman maggots that night, so off he went.

Similarly, a lot of ambulances are private, and won't pick up an uninsured patient from an ER who is being 'referred'.

Some private hospitals with 'liberal' policies will stabilize, others don't care as long as you don't die on property.

That said... MANY private hospitals (church based, childrens, etc), will treat anyone regardless of their ability to pay. And SOME docs and nurses will risk their licenses to treat a known uninsured case. Most don't.

Nearly everyone in healthcare that I know HATES the insurance game. Because people die.

The 'pre existing condition' part is esp bad, because if someone has a king term illness and is the primary... They often lose their insurance. My good friend in oncology says at least 1/4 of her patients get 'dropped' mid chemo or radiation (and subsequently die)... Because they got cancer, lost their jobs, and as such lose their insurance. Can't afford COBRA, because they can't work!!! Nowhere near enough funding in Medicaid or their previous years tax return is used and too high. Then précis ting conditions keep them from being able to get new or be added. Some oncology depts won't even treat unless you can prepay these days, purely because this is so freakin common.

Sorry. Our healthcare system is JACKED. No one hates it more than those who have to watch needless deaths. I'll never understand the minority if HCPs (there's always 2 or 3 in every hospital) who don't give a rats patoot. The only thing I can think of is that they got into medicine for the money.

But yeah... In some states, ERs are free. And in ones that aren't, people give ERs fake info.

Not all uninsured people are as conscientious as you as they should be. They will receive their bills and toss them aside and not think about paying them. This in turn causes hospitals to charge more for their services to cover their costs, so in essence those who pay, primarily the insured, pay for the uninsured in the long run.

Oh, and by the way, if they accept your $5 payment and they send your bill to collections, if it ever went to court (on their dime) nothing would happen because you ARE paying : )

If you can't pay the bill the eventually write it off. There are thousands and thousands of people who are in the same boat. I am one of them Our hospital has a free clinic but the income for the whole family has to be under $600 per month. That's a lot less than my hubby's SSDI. The kids get state medical cards, hubby has medicare, I have nothing and even if insurance was offered to me I could not afford it.

We live on mac and cheese and free meals for the hungry. We do not qualify for food stamps since Obama cut them. We get free food through the local food banks but 80% of it is out of date stuff that is not usable.

My family would have to do without food for me to pay for insurance. I will just have to do without.

The man went about it all wrong. If everyone has enough food and has medical care there would be less crime, less hatred, less jealousy, less animosity. We would be a better country if the poor were not constantly being made more poor and more of a scapegoat.

Until someone is elected that will truly fix our country and stop making the people who have money better off then our country is going to keep getting weaker and weaker.

I will not buy insurance of any sort and I will have to continue to rely on the local ER's to be my medical staff. I don't know who will pay the bill because my family is going to continue to have groceries and electricity and running water instead.

Some people may think that a nationwide medical plan is wrong, socialistic but perhaps those societies like England, Canada, and lots of others that have free medical care have the better more advanced thinking countries in the world.

You do realize that when a creditor sells your debt to a collection agency, they only receive pennies on the dollar. So, the hospital/creditor doesn't get paid in full. The creditor still suffers a loss.

Someone makes up that loss and those someone's are the people that actually pay their bills (whether insured or uninsured).

We all suffer higher costs and premiums when the bills don't get paid.

The issue is that the hospitals get paid by SOMEONE when people can't pay their bills. Say someone has a $10K bill for an emergency but can only make minimal payments or not payments at all. Even if it goes to collections, etc. you can't get blood from a stone. And they can't take back the "product" from you and sell it to someone else. If you don't pay your car loan, the lender takes your car and sells it to someone else. If you don't pay your mortgage, they take your house and sell it to someone else. Credit cards are a different story - they already have collected obscene amounts of interest from other payers and then they jack up your rate, damage your credit and prevent you from making future purchases. The hospital is not in the business of extending credit, and they can't NOT treat you if you show up in an emergency again.

So...there are government funds that reimburse the hospitals for treating uninsured patients, and no doubt some of the ridiculous costs of hospital procedures have excess baked into them to account for their uninsured losses, so people who DO have insurance pay higher rates for insurance because the insurance companies are paying inflated hospital bills. The cost for treating all of those uninsured patients gets spread around to the government and insurance companies. We are already paying those bills. Mandated health care just means that everyone has skin in the game now and the insured and people who pay taxes won't be shouldering all of the expenses for those who participate in our health care system without contributing to the costs.

While you are still ethically responsible for your bills, many people either do not have the money or choose not to use it and simply do NOT PAY their bills. When bills go to collection, if the collection agency collects anything it is often way less than the bill. The collection agency also takes a substantial cut of anything collected. If there is no money (unemployed, no savings) then there is no money and no one gets paid. So many emergency departments do not get paid for many if not most of the uninsured. They build this into their fees for the insured so the rest of us who are paying for health insurance are paying for our own care plus the care of the uninsured.

The way I understand it is that an ER cannot turn you down, so you WILL get treated.... and if you dont pay for it, someone else has to, or the hospital eventually goes belly up. I have seen a lot of great hospitals close in the last 10 years.

it depends on whether you visited the ER in a private hospital or a public hospital. We pay a hospital tax on the county hospital on our property taxes every year. That produces a lot of money for the hospital to use for uncompensated care. Many hospitals have non-profit foundations that provide funds to the hospital for projects and charity care. Have you audited the bills you received from the hospital. Have you asked for discounts equal to what they would give the insurance carrier who they are contracted with?? Like other folk said, you are being responsible. Many people just chose not to pay their bills.

If people don't have money, they don't have money, and you "can't squeeze blood from a turnip". ERs can also not legally turn people away without providing "stabilizing care". So, you have people being treated in the ER that never do pay for their care.

Some people qualify to receive healthcare through the government at zero cost. (I think they get medicaid, but I'm not sure). Not all doctors will accept it, but the ER must.

I know of someone whose family has this. They were talking about how the wife needed to have surgery, and the husband said she should wait until he found out whether or not he got the job that offered benefits. She thought she should not, as right now it would be free. If they waited, they would have to pay something because his health insurance wouldn't be free. (Turns out the company closed down and he never did get a job with benefits.)

This family goes to the ER for the dumbest things - a cough or cold, ear ache, a child who may or may not be constipated. It's ridiculous!

This would be an example of a family abusing the system, but it's also an example of something driving up the healthcare costs.

I haven't read the responses, but I will tell you that in California, and I believe other states, state law requires county hospitals to pay for indigent care under the Welfare and Institutions Code. So, if an uninsured person goes to a county hospital and is deemed indigent (many don't even provide valid information to make the determination), then the debt is required to be written off. That type of care is paid by the taxpayers.

Unfortunately a large amount of the cost comes from people, both insured and uninsured, using the ER as a doctor's office. An ER is required to provide service whether you have insurance or not, whether you can pay or not. Your situation required urgent care. A sore throat does not, it can be treated at a walk in clinic.

In the case of a sore throat, the cost of going to the ER is a lot higher as there's much more overhead. If the person is insured on a government program, we the tax payers need to pick up that additional cost.

If every uninsured person paid $5 a month for their medical bills, do you really think the bill will *ever* get paid off? Hospitals know that $5 is nothing compared to the amount of the bill so they jack up the costs to the people that have insurance. If I could get away with paying $5 a month for medical bills instead of my $1,000 a month premium, we would be a lot better off.

Also their are a lot of people that get paid cash. They use the ER and toss their bills. Why pay them, their isn't a tracking system and they cannot be denied care.

As for the collection agency paying the hospital bill for you and then collecting it from the individual, well that's just ridiculous. A collection agency gets paid pennies on the dollar. So if you owe $20,000 and they can collect $2,000 from you, that is an $18,000 deficit, how would a collection agency stay in business? BTW I used to work with collection agency's.

It sounds like you are a good person that is doing the best you can with what you have, keep it up, whether it's $5 or $500. Remember someone is paying, nothing is free and the government is not a business that can print money whenever it feels like it. Privately funded programs get money from donors & insured people to help people like you.

i work at a hospital ad we had a meeting and we're covered by non profits so goverment doesnt pay
the new law states we can not charge a patient more than what we charge insurance companies---so no more jacking up prices for regualr uninsure patients no matter what their income is....we already do this where I work though=)

An ER cannot turn you away if it is an emergency, regardless of your ability to pay. However, an emergency usually constitutes life or death/severe disfigurement/disability. Uninsured persons cannot use an ER as preventative care or even urgent care, and the ER treatment is limited to stabilizing you, not exactly fixing you. That is up the hospital's discretion.

And as you have learned, the hospital will certainly try to recoup any and all costs of your care and what they finally receive really is based on your ability to pay.

I have seen many arguments about uninsured or illegal persons using the ER for things like pneumonia or a sprained ankle and "getting away with it" but in reality, the hospital can choose how to proceed with those situations and are under no obligation to treat them. Sadly, without the cheaper initial care the pneumonia can progress to an actual emergency that ends up costing someone a hell of a lot more - either the family is completely bankrupt or the hospital writes it off.