Can a Hospital Refuse Treatment Without Insurance?

by Tom Streissguth
Federal law requires some hospitals to treat all acute emergency patients.

Lacking health insurance can prevent you from getting medical treatment, but federal law makes one exception for hospital emergency rooms. The law dates to 1986 and the passage of the Emergency Medical Treatment and Active Labor Act. This requires certain hospitals to treat acutely ill patients, whether or not they have medical insurance.

Covered Hospitals

The Emergency Medical Treatment and Active Labor Act provides that any hospital accepting funds from the Centers for Medicaid and Medicare must accept all acute patients that present at an emergency room. The majority of hospitals accept reimbursements from CMS -- Medicare and Medicaid -- since this is the only health insurance available to a significant portion of their patients. The law applies uniformly across the United States and all US territories.

Fines and Penalties

Any hospital in violation of the EMTALA can be assessed fines of up to $50,000 for every violation of the law. If the hospital has less than 100 beds, then the maximum fine is $25,000. The CMS can also terminate its Medicare agreement with the hospital, meaning the hospital would receive no reimbursement for services provided to patients covered by Medicare insurance.

Screening and Discharge

To comply with the law, hospitals must screen anyone who arrives at the emergency room to determine if the condition is acute. The legal definition of acute is having symptoms of "sufficient severity, such as severe pain, for which the lack of immediate medical attention could reasonably be expected to result in placing the patient in serious jeopardy." The formal name for the process is medical screening examination, and it includes active labor for pregnant women. After performing the MSE, the hospital may not transfer the acute patient to another facility unless it lacks the resources to treat the patient. Once the patient is stable, the hospital may discharge the patient and has no further legal obligation for treatment.

ER Charges and Collections

The law requiring acute care in emergency rooms does not also require free treatment. The hospital providing the care may bill for that care, and if the bill goes unpaid, has the right to pursue the balance through debt-collection action. After getting a judgment in court, the hospital may have the right to enforce a judgment through garnishment of wages, bank account levies or the seizure of property, depending on state law. In addition, the hospital has no obligation to provide follow-up treatment, prescriptions, medical tests or rehabilitation.

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About the Author

Founder/president of the innovative reference publisher The Archive LLC, Tom Streissguth has been a self-employed business owner, independent bookseller and freelance author in the school/library market. Holding a bachelor's degree from Yale, Streissguth has published more than 100 works of history, biography, current affairs and geography for young readers.

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