It makes sense to have health insurance as it helps you subsidize medical bills. However, buying health insurance may not be an option for you probably because it is expensive and you cannot afford it, or because you are in-between jobs and waiting for your new health coverage to take effect. Lacking insurance at a time when medical bills are on the high side can be difficult for you. And since most medical bills are negotiated and paid by patients’ insurance companies, you may want to know if a hospital can refuse you treatment because you lack one.
If you lack health insurance, a hospital still needs to offer you emergency care, and failure to do so can result in medical malpractice. Emergency conditions include serious impairment of organs and bodily functions, severe accident, and so on.
Health insurance remains an essential asset in the United States. Without health insurance, a severe accident or emergency case could result in massive debt or worse bankruptcy. In addition, health insurance helps to reduce your medical bill by providing coverage for medical services like surgeries, prescription drugs, and so on. Given the importance of health insurance, can hospitals turn you away if you don’t have one? What if you had serve accident and require emergency care? Can a hospital refuse to treat you because you lack insurance? If you need answers to these questions, I suggest you stay glued.
Can a Hospital Refuse to Treat a Patient Without Insurance?
Of course, having active insurance is a prerequisite for receiving health care in hospitals. But can a hospital refuse to treat you if you lack one? Read on to find out.
What Is Health Insurance?
Health insurance is a type of insurance coverage that pays for medical, surgical, prescription drug and even dental expenses incurred by the insured individual.
Health insurance can repay the insured for expenses incurred from sickness or injury, or negotiate payment with the care provider directly. It is always added in the employer benefit package to attract good employees, with premiums partly covered by the employer but often also removed from the employee salary.
The cost of health insurance premiums is deductible to the insured, and the benefits obtained are not taxable. However, there are some exceptions for S Corporate Employees.
How Does Health Insurance Work?
Health insurance works in a simple way. Making up your mind regarding the insurance plan to buy is the first step. Usually, your medical insurance is offered annually, and it has to be renewed annually after expiry.
While your insurance coverage is on, in the event of hospitalization of an insured individual, it’s apparent that you’ll make a claim for your healthcare needs. After making a claim, it is left for the insurance company to determine whether the treatment that is needed by the insured is covered under the insurance policy. If it is covered, the next thing the insurer does is to determine if the hospital where the insured is getting his treatment is in its network.
Suppose you are receiving your treatment with a networked hospital. In that case, you’ll be eligible for cashless hospitalization, and the TPA (Third Party Administrator) is usually the one liable for paying your hospitalization bills.
The third-party administrator will validate the details of your mediclaim policy. If it comes with a deductible clause or if the overall amount of your bills is more than the amount of your sum insured, you will have to pay your part of the bill, and your insurer will sort the remaining. However, if that clause doesn’t exist, your full hospital bill will be taken care of by the insurer.
Having brushed you up a bit on what health insurance is, let’s consider one common question among individuals who lack health insurance: Can a hospital turn you away if you lack insurance?
Can Hospitals Refuse Patients Treatment Because of Insurance?
While there is no specific answer to this question, state and federal law vary on this issue. However, you must note that according to the Federal Emergency Medical Treatment and Active Labor Act ( EMTALA), hospitals are required to provide healthcare services during an emergency regardless of if the patient is insured or not. Failure of a hospital to provide healthcare services to an individual suffering from a critical health condition could result in medical malpractice.
Aside from instructing hospitals to treat individuals with emergency medical conditions regardless of insurance, the EMTALA went ahead to define an emergency medical condition, including how far a doctor or medical staff must go to “stabilize” the patient.
Of course, a doctor has the right to deny treatment for several reasons. However, they cannot refuse to treat individuals with life-threatening or severe injuries even if they lack health insurance or the money to pay.
When Can a Hospital Refuse Patients?
Doctors can refuse medical care for the following reasons:
- Patients are requesting narcotics because they are addicted to that drug
- The patient isn’t ill
- A patient is exhibiting a wild behavior
- The doctor’s office has no openings, thus is no more taking in new patients for basic care (this only applies in a non-emergency situation)
What Happens if You Don’t Have Insurance?
A client of mine once asked me this question. She couldn’t afford insurance and wanted to know what would happen if she visited a hospital for medical care.
Like I advised the lady who asked this question, if you don’t have insurance, make an effort to have one. It can save you a lot of money!
In addition, you should note that, if you don’t have insurance, you will be responsible for the whole bill, both from the hospital or a doctor who accepts you as a patient.
Are Hospitals Legally Required to Provide Care?
Just as schools are required to offer students the best educations, do you think hospitals are legally required to provide care? This is a very good question people don’t ask. And I think knowing the answer to this question will help you understand if a hospital can deny you care ( regardless of the situation you find yourself in) or not.
Hospitals are legally required to provide medical care to individuals, especially those with life-threatening or severe conditions. If a hospital fails to provide medical care to an individual in need of medical emergency treatment, the hospital can be sued.
Having health insurance is beneficial in times of medical care needs. If you can afford it, don’t hesitate to buy one; you’ll be shocked at how much money you’ll save. Also, if you believe that you were wrongly denied medical treatment, speak with a lawyer.