Can a Hospital Refuse to Treat You Unless You Pay Upfront? The Answer May Surprise You

Imagine that you're hiking, fall, and break your leg. A friend gets you to the nearest hospital, where you're told you'll need to cough up your insurance deductible before X-rays are taken. Unfortunately, you're on a high-deductible insurance plan and don't have an extra $3,000. Is what the hospital doing legal? Do you have any recourse? Here, we dig into these questions.

A nation without universal healthcare

There are 195 countries on this planet and 152 offer free or universal healthcare to at least 90% of their citizens. The United States does not. In fact, the U.S. is the only country in the developed world without a universal healthcare system. We join countries like Iran, Pakistan, Yemen, and Nigeria in allowing the uninsured sick to fend for themselves.

What does a lack of universal healthcare have to do with hospitals demanding prepayment? According to Very Well Health, between the uninsured, underinsured, and the number of people living without enough savings to cover such an emergency, hospitals "know after the procedure is completed, people may not pay what they owe."

So what happens to the roughly 30 million Americans who are uninsured when they are injured or ill? What about the 56% of Americans who say they don't have enough money saved to cover a $1,000 emergency and cannot make a large upfront payment before receiving care? Are U.S. hospitals required to treat them when they show up in the emergency room?

The answer is both "yes" and "no."

EMTALA

A federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA) requires almost all hospitals to provide emergency medical treatment, regardless of whether the patient has health insurance.

EMTALA applies to all hospitals that:

• Have an emergency department
• Accept Medicare payments from the federal government

According to All Law, nearly every hospital in the U.S. meets both of these requirements, meaning they should all provide emergency medical care, no matter what. Can't produce an insurance card or pay a medical bill upfront? They should still offer stabilizing treatment.

You don't even have to make it into the emergency room. EMTALA states that you should receive emergency treatment as long as you're on hospital property and within 250 yards of the main hospital building.

Two reasons hospitals should not request upfront payment

Any medical facility without an emergency room (like your doctor's office) can request payment upfront. However, there are two primary reasons your local hospital probably cannot deny care:

1. The contracts signed by insurance providers and medical providers normally prohibit medical providers from requiring payment before medical services are provided, reports Very Well Health.
2. Per the American College of Emergency Physicians (ACEP), emergency departments are unique, and anyone with an emergency must be treated or stabilized, regardless of their ability to pay.

Hospitals know the rules, but that doesn't mean all follow them.

Exceptions to the rule

While the EMTALA makes it clear that hospitals must treat or stabilize anyone who comes to them with an emergency, there are exceptions to the rule.

Here are the scenarios under which a hospital can refuse to admit or treat a patient:

• When it's a non-emergency case and the patient does not have health insurance.
• When the hospital is short on resources. For example, a hospital that is short-staffed, needs more medical supplies, is overcrowded, or needs more beds can look for another hospital to treat the patient.
• When a hospital believes a patient would receive better treatment at a different hospital. For example, if a heart transplant patient comes into the E.R. exhibiting signs of organ rejection, a small hospital may seek a larger facility with transplant surgeons on staff.
• When a hospital does not have the medical personnel or equipment required to properly treat a patient.

Under no circumstances can a hospital deny treatment based on age, sex, or religious affiliation.

The bottom line is this: While hospitals are required by law to provide care to all patients suffering from a medical emergency, there are circumstances under which they are permitted to deny service. However, you're unlikely to know that until you're at the hospital.

No matter what your financial situation is or whether you have health insurance, you should always seek medical attention when you need it. There's no reason to risk your life over fear that you may not be treated. If your condition is serious, hospitals must stabilize you and/or find another hospital to continue your treatment. Hospitals can be legally liable for injury or death resulting from failure to treat or admit you.