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

Answer 1

AnswerIf 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.

Answer 2

In the state of Illinois and I think the United States in general, hospitals must see every patients that come to the ER. They also must admit any patient that needs medical care regardless of payor source. If patient needs an elective surgery or something outpatient I do not think that the hospital is required to perform the surgery. If a patient comes in through the ER and it is discovered that the patient needs a surgery once they have been admitted the surgery is done regardless of payor source. That is only my understanding, I could be misinformed.

Answer 3

Yes they can, unless the treatment required is considered to be emergency treatment.

EMTALA, (Emergency Medical Treatment and Active Labor Act) requires hospitals and ambulance services to treat injured people, regardless of race, color, creed, citizenship, or ability to pay. And the patient may not be released without their informed consent or if the hospital lacks the facilities to handle the victim's condition and must transport the patient to a better equipped hospital.

As to what constitutes an emergency versus a chronic injury, minor injury, &c., is open to debate.

From the hospital's standpoint, it's legally very dangerous to turn away a patient presenting with what the patient considers to be an emergency. While some conditions are obviously non-emergent, sometimes it's hard to tell, and releasing a patient may open the hospital to litigation. So most reputable facilities will take the more conservative course and treat the patient.

This of course does not apply to elective procedures. Nor does it apply to some clinics.

If you are experiencing and emergency and the hospital indicates they won't treat you, sometimes just the mention of the acronym, EMTALA will help.

Answer 4

No, legally everyone has the right to get treated. A hospital can't refuse to treat you if you are bleeding to death.

Answer 5

no, if you have insurace, they have to give you treatment. either that or they get fired.