Case Study

You are a finance administrator and a patient has no insurance or monies to pay for their care. What resources can you provide to ensure the patient is treated?

Discussion Guidelines

Remember to use citations and references as appropriate. Your post should be of at least 250 words in length and in appropriate APA style

EXAMPLE:

The Emergency Medical Treatment and Labor Act (EMTALA), passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation, ensures no person will be denied emergency lifesaving services regardless of whether or not they have private insurance, Medicare, Medicaid, or no supplemental coverage at all.. If a patient presents to the emergency department, EMTALA law takes effect by requiring the emergency department to perform a medical screen to determine if a life threatening event is taking place, and to provide treatment to stabilize the patient prior to determining whether or not the patient is covered by Medicaid, Medicare, or other form of insurance (Emergency medical treatment and labor act, 2012).

Although this law requires the patient to be treated, it does not prevent the hospital or providers from billing for services rendered, so patients may still be responsible for payment for medical expenses.  The finance administrator may be able to work with the patient/family to develop a payment plan that would meet the needs of the family, but they still may face non-payment which will either have to be written off or paid by any grants or donated funds allocated to pay for services under these circumstances. Many hospitals have internal Social Services departments that can be consulted once it is determined that a patient does not have any type of insurance coverage and does not have the means to pay for the services rendered. These social workers can work with patients/families in applying for Medicaid if eligible, as well as working with the patient/family in finding local resources that can assist with their care.  There are also special pediatric resources available, such as Children’s Health Insurance Program (CHIP), which is a low to no cost insurance available to children whose families do not qualify for Medicaid (The children’s health insurance program, n.d.).

Emergency medical treatment and labor act. (2012). Centers for Medicare and Medicaid Services. Retrieved on February 25, 2015 from https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/emtala/

The children’s health insurance program (n.d.). HealthCare.gov. Retrieved on February 25, 2015 from https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/