At what point does insurance get involved? Do you speak to your insurance people when you go to somewhere like a hospital or do the doctors all handle it behind scenes?
I would differ from Liz just a little bit here though not exactly.
If you are walking wounded there are administration questions you will be asked. But no one contacts one's insurance. You get treated and depending on the setting you might pay a copay but even if you owe one, not all EDs are in a partnership with the third party payers.
So for example, when I go to my HMO's ED, insurance and the medical care system are integrated. They'll ask for my copay. But if I go in an ED not connected to my HMO, they are not in the business of collecting payments for my insurer. I give my insurance info, the hospital bills the insurer, the insurer bills me the copay and other deductibles. Anything the insurance doesn't pay, the hospital will then bill me. Except sometimes the hospital is part of a "preferred provider" system in which case they agree to a certain fee schedule set up by the insurer. That amount still may or may not mean there is any uncovered amount the hospital then bills me.
If you are uninsured the hospital sends you a bill later.
EDs cannot by law turn anyone away, insurance or not. The same is true for the 3 day psych hold. Once you get to the psych facility their administration starts working on getting some kind of payment for you. Often that involves Medicaid and a whole bunch of other financial maneuvers because even with insurance there are always caveats on reimbursing for inpatient care.
You also have to keep in mind, health care providers are not directly involved in billing. No ED doctor sits around saying, get rid of this patient because he's uninsured. But sometimes they are involved in the financial aspects of the business. Different hospitals pressure the medical providers to different degrees to dump non-paying patients. Costs for patients who can't or don't pay their bills are absorbed by the hospital as bad debt. That essentially means, paying customers get billed a little bit to cover those patients who can't or don't pay.
And in some cases the doctor bills a patient and the hospital bills separately. It depends if the doctor has a private practice and uses the hospital setting, or if the doctor is an employee of the hospital. In some cases the docs are provided by a company that employs the doctors, or the doctors are a group practice of ED providers.
It can be very complicated. And yes, it is a bizarre and inefficient system. And if you think that's bad, you should see what the itemized bill looks like.
But readers don't need all that unless you want the medical bill to be part of the story.