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Thread: Non-insured hospital stay in USA

  1. #1
    Professor of applied misanthropy Drachen Jager's Avatar
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    Non-insured hospital stay in USA

    In a large American city, either current day, or just a few years ago, when an uninsured patient was treated to emergency care only if they didn't produce a means of payment.

    Here's the situation as I'm planning it.

    Teenager took a beating and suffered a concussion. He was taken to hospital and given basic care until he recovered consciousness. He can get MRIs and such, or not, I don't really care about treatment while he's under since he's unconscious and the story is from his POV (though if there's anything he would notice upon waking in his hospital bed that'd be good to know). Once he's up and about the hospital discharges him immediately.

    Does that sound about right?

    Is there anything else? What kind of ward would he awake in? Long room with multiple curtained-off beds or something?
    Last edited by Drachen Jager; 11-14-2012 at 09:21 AM.

  2. #2
    Uninsured patients only receive emergency care even today. The hospitals are only required to stabilize them.

    How long do you want the teenager to be unconscious? A concussion wouldn't cause lengthy unconsciousness; if any it'd be a couple of minutes maximum. Loss of consciousness is a symptom and the longer it lasts, the more likely it is that there is a serious problem. Concussions are generally not serious. There's no special treatment for them and they usually heal without lasting damage. So if the teenager was out long enough to make it all the way to the hospital through the ED and into a ward I doubt he got away with a concussion. I'd expect any ward he wakes up in to be the ICU.

    A concussion is usually determined by whatever symptoms the patient experiences and a neurological exam, for which you have to be conscious. Some patients also get a CT scan. If all of that is clear they can be discharged (into the care of a responsible adult if the patient is a kid), otherwise keep for observation.

  3. #3
    Professor of applied misanthropy Drachen Jager's Avatar
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    Quote Originally Posted by asroc View Post
    Uninsured patients only receive emergency care even today. The hospitals are only required to stabilize them.
    I was unsure whether that would still be current, with the changing healthcare in the US.

    I was figuring he'd wake up in the ICU. Whether it's a concussion or not is irrelevant to the story, but I'll make sure not to call it that, so I don't get things wrong.

    There aren't any responsible adults, but he's sixteen or seventeen so he's just going to get the bus home on his own.

  4. #4
    It's too hot to play. SuperModerator alleycat's Avatar
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    Quote Originally Posted by Drachen Jager View Post
    Is there anything else? What kind of ward would he awake in? Long room with multiple curtained-off beds or something?
    Yes, if he's still in the emergency room. It is generally along an open corridor rather than just seeming like one one huge room.

    I can describe one further if you'd like, but they're all different; it just depends on the plan of the hospital.
    Last edited by alleycat; 11-14-2012 at 11:03 AM.



  5. #5
    It's too hot to play. SuperModerator alleycat's Avatar
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    By the way, the location would make a difference. For example, here in Tennessee all minors are basically covered by a state insurance plan if they don't have private insurance. I'm not sure of the details of how it works.



  6. #6
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    Five years ago I had an emergency appendectomy, which fortunately turned out to be pretty routine (the damthing hadn't burst). I was admitted late at night, with surgery the next morning, and I don't recall if it was before or after surgery, but at one point some kind of administrative person came in to see me with a questionnaire, on which was asked: Are you worried about paying your bill. To which I answered Yes.

    This flummoxed the person, who came in a little later to ask why I was worried. To which my answer was, Isn't everybody? I had insurance, but with a high deductible. He seemed completely unable to parse that answer, and left without further discussion.

    I wound up paying the deductible ($5000 as I recall) out of pocket, the rest the insurance paid.

    But that's probably about as good as it gets in the U.S., unless you're Mitt Romney or one of his peers.

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  7. #7
    Always curious. juniper's Avatar
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    Ok, just got home from my job at the ER. So here goes.

    BTW, alleycat is right about each hospital being different. Depends on when it was last remodeled, is it a smaller community hospital in a suburb or is it an inner city facility with trauma care, is it a teaching hospital ... a lot of variables.

    Quote Originally Posted by Drachen Jager View Post
    In a large American city, either current day, or just a few years ago, when an uninsured patient was treated to emergency care only if they didn't produce a means of payment.

    Here's the situation as I'm planning it.

    Teenager took a beating and suffered a concussion. He was taken to hospital and given basic care until he recovered consciousness. He can get MRIs and such, or not, I don't really care about treatment while he's under since he's unconscious and the story is from his POV (though if there's anything he would notice upon waking in his hospital bed that'd be good to know). Once he's up and about the hospital discharges him immediately.

    Does that sound about right?
    How old is the teenager? Over 18 is considered an adult and would be treated in the adult side. Under 18 would be treated in pediatrics side, or transferred to a children's hospital. That's if he is admitted as an inpatient (out of the emergency room, into a regular room upstairs).

    CT scan more likely than MRI for a concussion. Most concussions don't require overnight stay. Not much can be done, really - it's just rest for recovery. Only reason I know of that someone would stay over is if the CT shows a brain bleed.

    If he's under 18, parents or guardians would be located to approve the treatment, if possible. We still treat without parents' permission in cases of emergency, but for anything beyond that, wait for parents. UNLESS the patient is 15 or older and asks that parents not be notified. State law here says 15 years old is age of consent for medical care.

    At the hospital group I work at (5 non-profit hospitals) we take uninsured patients with medically necessary treatments. We give you a packet of info about applying for financial assistance. You fill it out and mail it back. That puts you into the system for our financial counselors to consider. Last year we provided $67 million dollars of charity care to uninsured patients. It's based on patient income and their ability to pay.

    There are some for-profit hospitals (none around here that I know of) in some places, and their financial dealings are handled differently. Don't know about that.

    Is there anything else? What kind of ward would he awake in? Long room with multiple curtained-off beds or something?
    The hospital where I work has only private rooms, both in emergency and in the upstairs rooms. Rooms have both doors and long curtains for privacy. Two of our downtown hospitals have semi-private rooms, two beds per room, separated by curtains. That's also how it was when I was a patient in another state, several years ago. In a different state, all private rooms. I don't think any hospitals in the US have long rooms with many beds, at least not that I'm aware of.

    Hope this helps.
    Last edited by juniper; 11-14-2012 at 12:59 PM.
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  8. #8
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    As I understand it, the hospital involved would be significant. Some hospitals will only stabilize an uninsured person, while others are charged with caring for anyone who gets there. I know that in Boston Boston Medical Center (BMC) treats anyone, while Mass General, Brighams & Women's, etc. will stabilize and send patients on if they can't pay.

  9. #9
    practical experience, FTW McMich's Avatar
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    It really depends on the location. Each state has their own laws. (here in ohio they will reduce hospital bills by 15-100% if the family is up to 3 or 4 times povery levels- you just fill out a form on the bill)
    If he is there and awake and just cannot pay, they would not discharge him without an adult (if he is a minor) and they would not without extensive questioning. Every hospital charges whether you can pay or not. They would need an address and might even ask for verification to send the bill- even if he says he is not insured and cannot pay. If you want him to wake up and just leave the hospital, he would have to sneak out (and really, not all hospitals need any amount of sneaking to walk out)

  10. #10
    Professor of applied misanthropy Drachen Jager's Avatar
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    Thanks all. I'm not planning on giving a specific location, so that frees me up to pick and choose a bit. I had him waking up in a private room, but then I wasn't sure if that was realistic (thanks juniper).

    The details of the treatment are irrelevant unless it something he'd notice after waking, or it's a test they'd perform on him while he's conscious.

  11. #11
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    You definitely have some room to work. I was going to share my experiences with Illinois and Indiana. Instead, suffice it to say every hospital is different when it comes to rooms and when it comes to procedures for treating uninsured patients. Good luck!
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  12. #12
    practical experience, FTW
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    From the injuries you describe he wouldn't be in an ICU. There's nothing life threatening in the setup as you described that would require one of the few (and precious) ICU beds. A hospital doesn't fill up it's ICU beds unless it really is life threatening.

    In my experience working in three different ER's over a decade, he'd most likely stay in the ER and be discharged within 23 hours. (Likely sooner, but in any event there are administrative and payment advantages for discharging within 23 hours and, generally, anything over 24 hours is considered an "inpatient admission" instead of a "ER treatment".)

    Again, as you describe it, the injuries aren't severe enough to warrant admission to the hospital. The exception would be if you make the injuries more serious, add complications, etc. This assumes it was a concussion and related injuries, not serious brain trauma, etc.

    (Although if you really want him to be unconscious for hours, that implies much more than a concussion, maybe you could justify him staying longer. But, then, if the injuries were that severe, we're no longer talking about a "Ok, he's awake, send him home" type of scenario either.)

    In an ER he may be in a small room with a door or, more likely, in a curtained off treatment area in a line of similiar treatment beds.

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    I had to stay for several hours only for observation and waiting for test results more than anything. It was for an acute ulcer problem. I was just in a regular ER-room bed, made more like a bed than usual. They gave me a blanket and a pillow.

    It was in a big room with beds and individual curtains. There were machines all around the head of the bed, and I was hooked up to a heart monitor or something.

    In any case, it was a far cry from the ICU. I was wheelchaired down for the different imaging tests, then I was taken back to the ER bed to wait. Simple, I think They look like ER exam rooms on common American television shows or movies, so you are probably familiar with how that stage of care looks.
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    Benefactor Member WeaselFire's Avatar
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    In most of the US, there are public hospitals and private hospitals. Public hospitals get public funding and are required to care for those who cannot pay. Private hospitals are required to provide emergency service and stabilize a patient, who can then be transported to a public hospital. Note that a public hospital might be hours away.

    In almost all hospitals, ambulatory and stable patients are discharged. Insured or not. They aren't hotels.

    Every head injury or anything resulting in unconsciousness will involve MRI,s CT scans and usually a number of blood tests. Even poor patients can sue for failure to diagnose.

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    practical experience, FTW Lil's Avatar
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    I went to the emergency room, was admitted to the hospital, and spent two days there. It wasn't until I was being discharged that anyone asked about insurance or how I was going to pay.

    It depends on the hospital.

  16. #16
    Hello. My name is Inigo Montoya. kaitie's Avatar
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    Quote Originally Posted by Trebor1415 View Post
    From the injuries you describe he wouldn't be in an ICU. There's nothing life threatening in the setup as you described that would require one of the few (and precious) ICU beds. A hospital doesn't fill up it's ICU beds unless it really is life threatening.

    In my experience working in three different ER's over a decade, he'd most likely stay in the ER and be discharged within 23 hours. (Likely sooner, but in any event there are administrative and payment advantages for discharging within 23 hours and, generally, anything over 24 hours is considered an "inpatient admission" instead of a "ER treatment".)

    Again, as you describe it, the injuries aren't severe enough to warrant admission to the hospital. The exception would be if you make the injuries more serious, add complications, etc. This assumes it was a concussion and related injuries, not serious brain trauma, etc.

    (Although if you really want him to be unconscious for hours, that implies much more than a concussion, maybe you could justify him staying longer. But, then, if the injuries were that severe, we're no longer talking about a "Ok, he's awake, send him home" type of scenario either.)

    In an ER he may be in a small room with a door or, more likely, in a curtained off treatment area in a line of similiar treatment beds.

    I'm not sure about this because a head injury that would knock someone out for that amount of time would be serious and potentially life-threatening.

    I'm not a doctor, but my master's is in psychology and so we did a lot with head injuries. Anything that knocks you out is going to have a concussion. Anything that lasts more than a few seconds to a few minutes is going to be very serious (and even a minute or two isn't something to take lightly).

    If a patient is brought in with a head injury and still unconscious when they arrive at the hospital, they're going to have to do tests to determine whether or not there is bleeding in the brain and whether emergency surgery needs to be done to relieve it. And honestly, being unconscious for that long means that they will likely have to do something for him. This kind of traumatic brain injury can have very serious, long-term effects.

    If you're setting up a situation to deal with the fallout of such an injury, it's fine, but if you want a realistic portrayal of a head injury bad enough to make someone pass out for that long (and in books, granted, you don't have to be realistic, especially about something like this as it's a common mistake), it would be best to have him just knocked out temporarily, or perhaps conscious but disoriented and unable to remember what happened later on after he wakes up. Or he remembers, but it was all just a blur.
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  17. #17
    Professor of applied misanthropy Drachen Jager's Avatar
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    Thanks kaitie, I'd been thinking about that.

    What I've decided is that when he's conscious, one of the nurses will press him on insurance, or his info so they can bill his family. He knows his mom can't pay, so he sneaks out when the nurse is distracted.

    As far as fallout from the brain injury, well that's sort of central to the story.

    Not to worry about the actual brain injury though, I have a friend who's a neuroanatomist, so I can get the details right.

  18. #18
    ~~~~*~~~~ backslashbaby's Avatar
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    Oh, the insurance part, yeah! They asked briefly when I came in (in obvious pain, etc), but I was conscious. Then, later they had someone come to the bedside in the ER room with a stack of paperwork. I got the impression that pretty much if you can still work a pen, they'll have you get the paperwork done

    Mine was an application for aid/a plan to cover the costs I couldn't pay. Insured or uninsured, the costs can just be so high that oftentimes there are parts folks can't pay or would like some time to pay, etc.
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