Monday, November 30, 1998 - Page updated at 12:00 AM

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Law: Hospitals Can't Deny Emergency Care


WASHINGTON - It is late at night and your child has a fever, but if you go straight to the emergency room, you are not sure your health insurance will pay for it.

It is a concern hospitals have, too, now that so many Americans belong to "managed care" health plans that will not pay for most treatments unless patients get permission ahead of time. But it is not something doctors or nurses should pester you about when you walk into an emergency room, government regulators say.

"No managed care plan . . . can excuse a hospital from providing needed emergency medical screening and stabilizing care to an enrollee," said June Gibbs Brown, inspector general of the Health and Human Services Department.

Problems with delays while emergency-room staff check to see whether insurance will pay for care are on the rise, regulators say. In some cases, patients with potentially serious health conditions have left emergency rooms after being questioned about their insurance.

To deter such incidents, Brown plans to announce this week that the government will use a 12-year-old law against "patient dumping," which carries fines up to $50,000 per infraction. The 1986 statute bars hospital emergency rooms from refusing to examine and stabilize patients who cannot pay, and originally was intended mainly to protect people without health insurance.

American Hospital Association spokesman Rick Wade welcomed the clarification that hospitals also must aid - with no questions asked - those people whose health plans may restrict emergency coverage. But, he said, "It's not going to solve the problem of some (health insurance) plans deciding that they'll use pre-authorization rules as a way not to pay hospitals."

It has become increasingly common for health maintenance organizations and other insurance plans trying to control costs to refuse to pay for care unless patients first get permission from designated doctors.

Plans that cover elderly, disabled and low-income Americans in government health insurance programs such as Medicare or Medicaid must waive such requirements for emergency care in situations that a "prudent layperson" would judge to be a medical crisis - such as having symptoms of a heart attack. Congress this year considered imposing similar laws on the private sector, but gridlock in the Senate stymied the legislation.

Copyright (c) 1998 Seattle Times Company, All Rights Reserved.


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