Emergency Room Deductibles

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

Emergency Room Care ($302 per visit and 4 visits per year (each quarter) for 20 years) = $24,160

allowed to bill for any portion of the costs related to the hospital acquired infection including

Since the development of the EMTALA Act in 1986, any individual which presents to the emergency department, must be accessed and triaged by qualified medical personnel. (www.cms.gov) Individuals are aware that if they present to the emergency department, regardless if it is for just a tooth ache or a major illness like a heart attack, they will have to be treated. “This mandate does not extend to private physician offices, however, which creates an incentive for those without the means to pay for care to

Once the patient comes through the door payment for services should be top of mind. All copayments and deductibles collected and any other non-covered expenses billable to the patient. The correct information is gathered and if all is handled initially properly within in the cycle the claim can go the workflow and payment received with minimum effort by human hands.

A medical expense does not have to relate to a particular ailment to be deductible.

There shall be allowed as a deduction the expenses paid during the taxable year, not compensated for by insurance or otherwise, for medical care of the taxpayer, his spouse, or a dependent (as defined in section 152 , determined without regard to subsections (b)(1) , (b)(2), and (d)(1)(B) thereof), to the extent that such expenses exceed 7.5 percent of adjusted gross income.

(2) Patient admitted to emergency room via the county jail. The emergency room visit was billed to the jail.

One in particular states, “The hospital is professionally and ethically responsible for providing care, treatment, and services within its capability and law and regulations (Showalter,2013).” Patients may not always have the funds to be treated when their insurance coverage is not available. It would be up to the facility to decide how they are going to continue care in these situations. They have policies on the destruction of medical records. Another policy includes they must comply with the standards of emergency care. Also, that patients have access to interpreter services to include the most common languages used in the healthcare facility. These standards of care are updated all of the time by healthcare experts, nurses, staff, to ensure the most updated

What does it cover? “It cost around fifty dollars to see the primary doctors, and specialize doctor seventy-five dollars.” (www.ehealth.com, 2014) “The prescriptions cost from range from fifteen dollars for generics to out of the pocket on some name brand drugs.” (www.ehealth.com, 2014) Some the name brand drugs are mental disorder and they cost up to thousands of dollars for this one of those prescriptions alone. “Surgeries, x-rays, cat-scans, M.R.I’s all them are half of the cost of the procedure. That does not count price of ER is five hundred dollars and every day you stay in the hospital it extra five hundred dollars you pay every day that you are in there.” (www.ehealth.com, 2014) It would be cheaper than paying out the pocket for a hospital stay or most of those things besides the name brand prescriptions it the same price.

One of the contributors to the rising cost of Healthcare can be attributed to the over use of emergency departments (EDs) for non-emergency needs. In the greater Capitol/First/Beacon Hill area there are three major hospitals (Virginia Mason, Harborview, and Swedish) with emergency rooms and no urgent care centers with the exception of Group Health which is restricted to Group Health insurance members.

3) A study shows that availability of after-hours care by primary physicians reduces emergency room visits. Based on this study we can infer that it is likely that some of these individuals are forced to visit emergency rooms due the unavailability of after-hours care by primary physicians and lack of paid sick leave to reach the primary care physician during regular work hours. Paid sick leave will reduce the emergency room visits as employees can now contact their primary care physicians during work hours.

The rising costs of unpaid emergency room expenditures were an issue that had to be addressed by state authorities. EMTALA required that all persons be treated, however, it did not include any legislation to reimburse payment that left hospital left with unpaid bills and growing expenses.

More than likely, medicare covers most, if not all, of your expenses, if they are administered through a hospital or approved medical provider.

The emergency room has become the new primary care facility for the millions of uninsured in the United States. Thanks to an “unfunded mandate passed into law in 1986,” hospitals that participate in the Medicare program must “screen and treat anyone with an emergency medical condition” (Stephens & Ledlow, 2010). This unfortunately leads to emergency rooms full of people who may have something as simple as a sinus infection which then makes it really difficult for someone with a real emergency that did not require ambulatory transport to be seen in a timely manner. Another unfortunate result of this is that “over 1,100 emergency departments closed over the past decade” (Stephens & Ledlow, 2010).