Emergency room care: Know your rights

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If you’re in the emergency room, you’re probably too injured to haggle with hospital administrators about how you’ll pay for your care — especially if you don’t have health insurance. Fortunately, in 1986, Congress passed the Emergency Treatment and Labor Act (EMTALA) which prohibits a practice commonly known as patient dumping, which is the transfer of a patient from any private hospital to a public hospital because of the patient’s inability to pay for the treatment.

The act gives individuals the right to emergency care regardless of their ability to pay. EMTALA was enacted as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA).

The federal law applies to hospitals that participate in Medicare — most hospitals in the United States. EMTALA doesn’t apply to hospital outpatient clinics that aren’t equipped to handle medical emergencies. But they’re required to refer patients to a nearby emergency department.

Key Takeaways

If someone has an emergency medical condition, the hospital must provide care that stabilizes the person.
If you are not in an emergency situation and you do not have insurance, the hospital is not legally obliged to treat you.
Some health insurance companies deny emergency room claims if the person could have been treated at some other appropriate location.
If you think that the hospital or your insurance company treated you unfairly, you can contact your state’s department of health.

What emergency room laws entitle you to

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a federal law that requires hospitals to provide stabilizing treatment to anyone who comes to the emergency room, regardless of their insurance status.

Federal law requirements for hospitals

Offer timely and proper medical screening: Hospitals that accept payment through Medicaid or Medicare must provide emergency care to anyone who needs it, regardless of their ability to pay, insurance status, origin, race or color. The hospital must use appropriate resources for medical screening, such as lab tests or CT scans.
Stabilize patients with emergency medical conditions: A hospital must provide treatment to patients with any emergency medical condition until the patient’s health is stabilized. If the hospital can’t treat the emergency medical condition, they must provide an appropriate patient transfer to another hospital following the EMTALA provision.
Accept transfers of patients with emergency medical conditions: A hospital with specialized capabilities must accept patients from other hospitals that can’t treat unstable emergency medical conditions.

What emergency rooms aren’t required to do

If you’re not experiencing an emergency and don’t have medical insurance or the ability to pay, the hospital emergency room is not legally required to treat you. The hospital will most likely direct you to your doctor or a community health clinic. Additionally, some health insurers deny emergency room claims if the person could have been taken to a “more appropriate” location, such as a doctor’s office or an urgent care center. Because of this, it is wise to see your doctor or go to a retail clinic for non-emergency care.

The patient-dumping law was passed to ensure people who need immediate medical attention get the necessary medical care. If you have health insurance coverage, your insurance provider will pay the hospital bills. But if you don’t have health insurance, you will still be asked to make payment arrangements with the hospital.

Once your condition has stabilized, the hospital can move you to another facility.

According to the U.S. Department of Health and Human Services, the patient-dumping law also applies to HMOs that illegally demand pre-authorization for emergency room visits. Emergency room care can’t be delayed while a hospital tries to obtain insurance pre-authorization.

What is an emergency medical condition?

The EMTALA describes an emergency medical condition emergency as an illness, injury, or symptom that requires immediate medical attention to prevent serious harm to a person’s life. The absence of immediate medical attention could result in the following:

Placing the person’s health (or, for a pregnant woman, the health of the woman or their unborn child) in serious jeopardy
Serious impairment to bodily functions
Dysfunction of any bodily organ or part

If a pregnant woman is having contractions, an emergency medical condition exists when:

There is inadequate time to safely transfer to another hospital before delivery.
A transfer might threaten the health or safety of the woman or the unborn child.

An emergency is defined as a condition that poses a serious threat to your health or well-being and requires immediate medical treatment. This can include anything from a heart attack or stroke to a broken bone or severe burn. If you have doubts about whether your situation qualifies as an emergency, it’s always best to err on the side of caution and contact your insurer for guidance.

Individual state regulations affect how you’re treated in an emergency room and your health insurance company’s decision to pay for that treatment. Federal law gives you fundamental rights and your state laws might provide additional ones.

If you feel you have been treated unfairly by the hospital or your insurance company, call your state’s health department.

Can a hospital refuse to treat a patient without insurance?

No. Hospitals can’t refuse to treat a patient without insurance. Doctors must provide primary medical treatment even if you do not have health insurance coverage and end up in a hospital with an emergency medical condition.

EMTALA ensures that every patient has the right to emergency care and no one is denied life-saving services regardless of their insurance or financial status.

However, if you don’t have health insurance, you must pay for all the medical services you receive. This may include doctor’s fees, hospital stay, specialist payment and the cost of medicines.

Can an emergency room turn you away?

Usually, an emergency room can’t turn away any patient seeking medical assistance. However, if the hospital is swamped and the patient doesn’t have an emergency medical condition, they may ask the patient to either wait or reach out to another hospital.

Suppose a patient has a life-threatening medical condition and the hospital doesn’t have enough beds available. In that case, they may provide an ambulance and transfer the patient to the next closest hospital.

What are the penalties for an EMTALA violation?

Public Citizen, a consumer watchdog group, claims that despite the law, some hospitals still refuse to provide primary treatment for patients who can’t pay. The Office of Inspector General (OIG) can issue penalties under EMTALA. Those penalties may include:

Termination of Medicare agreement
Fines up to $50,000 for each violation
Lawsuits for personal injury in a civil court
A receiving facility affected by another hospital’s failure to comply can sue the hospital to recover damages
A violation can be cited even if the patient wasn’t severely hurt. A violation can’t be cited if the patient refuses examination and treatment unless there is evidence they were coerced.

“It’s distressing that this law has been in place and hospitals are still flouting it,” says Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group. “The government needs to do more to force hospitals to comply. People shouldn’t be denied desperately needed emergency medical care when they go to a hospital.”

What is an example of an EMTALA violation?

EMTALA violations can occur when a hospital fails to provide stabilizing treatment or transfers a patient before they have been stabilized. Sometimes, patients may also be discharged too early, before their condition has improved.

For example: If a patient develops chest pain while in a pediatric hospital, the staff in the pediatric emergency department is responsible for stabilizing the patient as best they can. This might include giving them oxygen and establishing IV access. If proper care is not provided to the patient, it will result in a violation of the Emergency Medical Treatment and Active Labor Act.

EMTALA violations have severe consequences for patients and hospitals, so hospitals must comply with the law.

Frequently asked questions

Are emergency rooms required to treat an uninsured person?

If you have a medical emergency, hospitals and emergency rooms are required to provide appropriate treatment regardless of your insurance status.

Do you have to pay upfront at an emergency room?

Hospitals require ER patients with routine problems to pay upfront. You may have to pay the hospital bills upfront if you do not have any emergency medical condition.

Who do you contact if you have questions about EMTALA?

If you need answers to any questions related to the EMTALA, you can reach out to the U.S. Dept. of Health & Human Services’ Guidance Portal. You can email your queries to guidance@hhs.gov.

Sources:

Social Security Law. “Examination and Treatment for Emergency Medical Conditions and Women in Labor.” Accessed August 2022.

National Library of Medicine. “How Long Can You Stay in the Emergency Department (ED).” Accessed August 2022.

Emtala.com. “Frequently Asked Questions about the Emergency Medical Treatment and Active Labor Act (EMTALA).” Accessed August 2022.

Shivani Gite

Contributing Writer

Shivani Gite is a personal finance and insurance writer with a degree in journalism and mass communication. She is passionate about making insurance topics easy to understand for people and helping them make better financial decisions.