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Can a hospital refuse treatment based on their assumption that the patients insurance will not cover treatment?

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If it is a life threating emergency no hospital can refuse treatment. Even if you are a adult and go to a children's hospital. They must stabalize you then they can tansfer you.



Non-profit hospitals are required to provide "community benefits" as a condition of their tax exempt status. Prior to 1969 non-profit status at the Federal level required treatment of all indigent patients. The IRS in 1969 changed the charity care requirements to "community benefits" which include bad debt (uncollected payment from patients who were expected to have been able to pay but didn't), shortfalls from Medicare and Medicaid reimbursements, and losses from the types of care that are money-losing such as burn units and neonatal intensive care. Broadening of these definitions led some non-profit hospitals to increase the other community benefits and reduce the charity care.

However, if the hospital is a "Participating Hospital", i.e., takes any government program funding from the Department of Health and Human Services, such as Medicare, and Medicaid, they must treat for emergency care or active labor regardless of the patients' ability to pay, citizenship, etc, and they must treat them like they would any other patient. This bill passed in 1986 and was called the Emergency Medical Treatment and Active Labor Act (EMTALA) under COBRA. This effectively covers all hospitals, profit or non-profit since the hospitals can not make it without the patients under government health care programs. The exceptions are the Shriners Hospitals for Children, Veterans Affairs Hospitals, and Indian Health Service.

This will vary state to state, too, since states have ammended to include additional rerquirements and define what services must be included.
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