ER visit, no health insurance

Well, that'd be fraud and if he gets caught...

On the other hand, rabies postexposure treatment is a multi-step process, so he'd have to keep faking it the entire time. My daughter was treated for it and it took about six weeks, all told. She was exposed in the beginning of May, 06, and we didn't wrap everything up until the end of June. Plus, we had to go to the ER for each one. Total bill was about $1500.

Hospitals are usually more than willing to work with you on the payment plan - setting up what you can afford (we're doing this right now for my husband's hospital stay last summer). The hospital where he was treated is very good about that.

Hope this helps.

In the real world, someone without insurance would either have to pony up some cash before treatment or could be refused treatment. Many ER departments will have large signs in place on the wall that state what injuries that they will treat without insurance.

Even with insurance in today's world, patients arriving via the ER will be aske to pay a upfront payment. My family has health insurance through my husband's work and we have a co-pay of $90 for an ER visit that is payable before the patient is seen by a doctor unless the situation is life threatening.

It might depend on the hospital - I don't think (and I'm no expert) a county-funded hospital could refuse treatment on the basis of not being able to pay. Especially for rabies, which would probably kill him if he had it.

My daughter went to the ER about two months ago with no insurance. They took her in and made her pay nothing at the time of treatment. The hospital wrote off their bill because she was a poor student, but she had to set up a payment plan with the doctor. Our hospital has to take anyone regardless of their ability to pay.

We pay our co-pay in the form of a bill that comes after the insurance company's paid the balance. It can take months.

Many if not all hospitals also have a debt-loss leader on a percentage of patients that they expect will not pay for whatever reason. These would be the indigent, poor/low income, or those whose insurance won't cover something for whatever reason.

Jersey Chick said:

It might depend on the hospital - I don't think (and I'm no expert) a county-funded hospital could refuse treatment on the basis of not being able to pay. Especially for rabies, which would probably kill him if he had it.

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Yes, and from what I've seen, private hospitals will transfer patients who cannot pay to county. Depending on the severity of the injury, of course.

Jersey Chick said:

It might depend on the hospital - I don't think (and I'm no expert) a county-funded hospital could refuse treatment on the basis of not being able to pay. Especially for rabies, which would probably kill him if he had it.

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I think that might depend upon the state. In Illinois, they have no problem turning you down unless you are signed up with Medicaid in advance and have the card with you. (In my area, a single person has to make less than $16,000 per year to qualify for Medicaid.)

Here it's what J's Annie said -- pay in advance or hit the door.(Remember the news story in Sept. 2007 about the woman who literally died in the waiting room of a California hospital? Her husband dialed 911, but they wouldn't send anyone, because she was already in the emergency room. The hospital wouldn't treat her because she was uninsured and the staff had recently been warned about accepting too many non-paying patients. Nurses literally stepped over her as she was convulsing on the floor.)

Most hospitals and doctors will work out a payment plan for the copays if you are insured. (After all, they are still getting the majority of the fee, from the insurance company.) That doesn't mean they will do anything similar for someone who is uninsured. Most hospitals are eager to keep debt/loss to a minimum, and they do that by not accepting patients who can't pay.



I'd have a lot of trouble believing that the staff of the hospital would intentionally commit insurance fraud on this guy's behalf. For one thing, if they are caught, every staff member who was aware of the problem could go to jail and/or lose their license to practice. For another thing, the entire hospital might lose it's accrediation over the issue. It's just too big a risk to take.

And, why is this guy so special to the hospital staff? Trust me, they see -- and turn away -- uninsured patients every single day. There are millions of uninsured people in this country. Doctors and hospital administrators can't afford to feel sorry for every one of them.

As a freelance writer, I don't have insurance. I've had the same doctor for 12 years. He charges me $110 per office visit, instead of $120 -- that's the extent of the "empathy" extended to most patients without insurance. And, it's cash on delivery, no payment plan. (And he's a nice guy!)


I would think a much more likely scenario would be that your character would use his friend's insurance card, without the hospital employees being aware of it. So Joe Blow would pretend that he is Steve Smith, to use Steve Smith's insurance card. I've noticed that doctors and hospitals seldom ask you for i.d. in addition to the insurance card. (Maybe if they do, the two look enough alike that Joe could use Steve's?)

It could start as a mix-up and just progress from there.

Also, attempted fraud is bad because: 1) it involves not just the hospital, but the insurance company, 2) in this case, rabies. Which is dangerous and rare. Using fake ID or another person's insurance for a broken nose or road rash is one thing, rabies is the kind of thing that people will remember and mention. "Look at that guy over there, he got bit by a rabid bat!" It's possible, I don't know the laws in Arizona, that the hospital may report the rabid bat-bite in the interests of public safety. Which means people asking lots of detailed questions. Is that what you want on top of a lie? Of course, if a doctor at the hospital was interested in rabies, he might help cut a deal on the bill?

Well I went to the emergency room a few years ago---didn't have to pay anything at the time...But did set up a payment plan.

I do like having your character using a different card...pretty clever by the way

johnnysannie said:

In the real world, someone without insurance would either have to pony up some cash before treatment or could be refused treatment.

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Nonsense.

I was in the ER for about a week total with no insurance a couple of years ago.

I had MRIs, ECGs, a spinal tap and possibly other tests & treatments I've managed to forget.

I never signed a thing, and have never received a bill. There was no question of refusing treatment.

Of course, if by 'real world' you mean some impoverished third world country, then yes, I guess you may be right.

But certainly not here in the civilised country of Australia!

Mac
(PS: Sarcasm aside, it might not be as easy as simply saying 'The patient has a fatal disease'. For a start, the hospital may want to do a TEST for rabies rather than simply saying 'the animal was acting odd before it bit the patient'.

So the procedure may be closer to :

1. Either get a biopsy from the bite area and do a cheap fluorescence test, or get a saliva sample from the patient and do a more expensive PCR test.

2. Start the patient on the treatment with the Rabies vaccine

3. If the rabies result comes back negative, stop the rabies treatment

So a hospital may not be obliged to start a treatment - because there is only a possibility that the patient has a fatal infection.
Otherwise, wouldn't the hospital be obliged to do a full study of EVERY single patient until they have a definitive non-fatal diagnosis?

Good luck!)

**Note: Speculation continues below - It is becoming clear that they recommend vaccinations against ANYONE who has become exposed.

Mac H. said:

Nonsense.

I was in the ER for about a week total with no insurance a couple of years ago.

I had MRIs, ECGs, a spinal tap and possibly other tests & treatments I've managed to forget.

I never signed a thing, and have never received a bill. There was no question of refusing treatment.

Of course, if by 'real world' you mean some impoverished third world country, then yes, I guess you may be right.

But certainly not here in the civilised country of Australia!

Mac
(PS: Sarcasm aside, it might not be as easy as simply saying 'The patient has a fatal disease'. For a start, the hospital may want to do a TEST for rabies rather than simply saying 'the animal was acting odd before it bit the patient'.

So the procedure may be closer to :

1. Either get a biopsy from the bite area and do a cheap fluorescence test, or get a saliva sample from the patient and do a more expensive PCR test.

2. Start the patient on the treatment with the Rabies vaccine

3. If the rabies result comes back negative, stop the rabies treatment

So a hospital may not be obliged to start a treatment - because there is only a possibility that the patient has a fatal infection.
Otherwise, wouldn't the hospital be obliged to do a full study of EVERY single patient until they have a definitive non-fatal diagnosis?

Good luck!)

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It's not nonsense. Not at all. By real world, I mean this United states of America. I know of real people, with names and faces (some relatives) who were turned away for no money. I know of a particular case where someone without insurance was not touched by ER staff until someone else showed up with cold, hard cash.

I would not presume to tell you how health care operates in Australia; please don't presume to call what I posted nonsense when you have no idea of the realities here.

johnnysannie said:

...please don't presume to call what I posted nonsense when you have no idea of the realities here.

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Sigh.

I thought it was pretty clear I wasn't serious.

Not only did I have obvious overstatements - I even had the much abused exclamation mark.

And to make 100% clear, I even started my 'PS' (which had my real post in it) with the phrase 'Sarcasm aside ...'

I know sarcasm can be easy to miss in written form, but when someone SAYS THAT IT IS SARCASM in the same post, it is undeniably clear.

When reading text and understanding what people say, here is a guide - sarcasm means that the phrase states the OPPOSITE of the literal meaning.

So when someone says 'Nonsense, that can't be true in a civilised nation - that would only apply to a third world country !' sarcastically, they really are agreeing that it is true, and using the opportunity to lament the state of civilisation.

What more can I do to make it clear?

I hope I don't have to resort to using those little 'winky' icons ...

Mac
(PS: And yes, Sarcasm is the lowest form of wit. It must be true - I read it on the internet.)

There is no definitive test for rabies in people - when we took my daughter, there was no testing done. They treated based on the possibility. Especially since we couldn't find the animal that scratched her. Unless the guy brought in the bat to have it tested, I think there is a greater likelihood that he'd just be treated as if infected.

Unless I'm reading this wrong: http://www.cdc.gov/rabies/diagnosis.html

This is an interesting discussion especially for the implication the char could be turned away. Totally tangential to the original question, but it's freaking Rabies, not a nail through the foot. Surely even in the USA the hospital would treat it as a matter public health because it's, you know, freaking RABIES??? Please tell me an affluent western democracy has some sort of contingency plan for uninsured people who are at risk of freaking Rabies?

If someone comes into an emergency room and thinks they have rabies, they will be treated. They might be sent to a clinic or county hospital for the subsequent shots, but no hospital can turn someone away with the kind of health risk that rabies has.

And it's not a matter of being sued, it's a matter of Government Health Dept.

Interesting. According to some guidelines :

[FONT=Arial, Helvetica, Geneva, Swiss, SunSans-Regular]

[FONT=Arial, Helvetica, Geneva, Swiss, SunSans-Regular]When someone has had a bite or scratch from a bat or possible direct contact with a bat, it is called an exposure. ... [/FONT][FONT=Arial, Helvetica, Geneva, Swiss, SunSans-Regular]If exposure of a person is likely to have occurred but the bat is not available for testing, Public Health and health care providers will recommend that the person receive rabies vaccination treatment[/FONT]

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I wonder what would happen if you turned up at a hospital and simply said that you'd woken to find a bat in the corner of your room.

The guidelines clearly recommend treatment .. would the Public Health system pay for it ?

After all, you aren't saying you HAVE rabies, you even say that it is incredibly unlikely that you have rabies.

You are just saying that you found a bat in the corner of the room and now want free vaccinations.

What would the health system do?

Mac[/FONT]

I think direct contact means physical contact in this situation. Bats are dirty, dirty vectors, but if one was just roosting in your room you'd call animal control/WIRES, not a doctor. Unless you suspected you'd inhaled lots of guano. I know I've had enough close encounters with bats at night just walking under trees in Sydney, but haven't got rabies yet.

They would probably treat as if you were exposed. According to what the doctor in the ER told us (and he was terrific - gave us a ton of info regarding rabies. More than I really wanted to hear, actually) they err on the side of caution because an unnecessary vaccination won't hurt you. Rabies will most likely kill you. And believe me, upon hearing what they do, no one accept a crazy is going to voluntarily go through the treatment. I've seen it - the first round is brutal.


ETA:

I think direct contact means physical contact in this situation. Bats are dirty, dirty vectors, but if one was just roosting in your room you'd call animal control/WIRES, not a doctor. Unless you suspected you'd inhaled lots of guano. I know I've had enough close encounters with bats at night just walking under trees in Sydney, but haven't got rabies yet.

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Around here, if you called Animal Control about a bat in your room, they will usually recommed you see a doctor because you could be bitten and not know it. Again, this is according to the info we received at the ER. Just touching a bat won't harm you, but if it bit or scratched - there is a possibility of rabies, no matter how small. Again, though, by the time symptoms appear, it's usually too late.

Well, my daughter was just admitted into the ER (then admitted into the hospital) about 1AM this morning. She has no insurance. They didn't ask her for money upfront. They haven't talked to her about how she's going to pay the bill. They told her that she'll have to go down and discuss that with the money people when she's discharged.

Can't get a whole pile more recent than that, I guess.

And, FWIW, they're still testing if it's appendicitis or not. Surgery is still possible for later today.

Fun rabies fact: 6 people have survived the onset of Rabies.

Ever.

Here's a few and thoughts for your daughter and a speedy recovery.

Jersey Chick said:

Around here, if you called Animal Control about a bat in your room, they will usually recommed you see a doctor because you could be bitten and not know it. Again, this is according to the info we received at the ER. Just touching a bat won't harm you, but if it bit or scratched - there is a possibility of rabies, no matter how small. Again, though, by the time symptoms appear, it's usually too late.

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Yeah, that's what I'm thinking. With regards to the original question, there's no way in hell a potential exposee would be turned away, seeing if they have got the big R and they can't afford to do something about it they are DEAD. Even in a futuristic corporate dystopia people would still get mandated care for rabies, because you couldn't have the Infected running around the slums biting people and reducing your pool of cheap labour, now, could you. I am getting a story idea now.

This thread reminded me of the most horrible and depressing news story ever: What happens when idiots refuse post-exposure prophylaxis: meerkats die