Can a Doctor Refuse to Treat a Patient Without Insurance?

It seems that healthcare has always been a hot issue and a lot of people are wondering about the physician’s right to refuse treatment to patients, especially if they do not have any health insurance or the ability to pay for the treatment. Well, it might be tricky to answer the question since doctors have taken an oath to take care and treat sick people; however, not all situations, doctors are required to treat patients. Hence, there is that one federal law that governs all hospitals and doctors regarding this topic.

According to Emergency Medical Treatment and Active Labor Act (EMTALA) that mandates almost all hospitals to treat all patients who seek emergency medical attention, regardless of having health insurance or not, until the patient becomes medically stable. Therefore, a doctor cannot refuse to treat patients without medical insurance.

It says that patients who seek emergency medical treatment are the ones who cannot be refused by doctors to give treatment, does that mean that they need to be admitted first to the emergency room? Well, you will get to know more about this below.

What are the Hospitals Governed by EMTALA?

Hospitals that are covered by EMTALA are those that accept either Medicare payments or not, as long as they are equipped with emergency departments. Since most of the hospitals are accredited by Medicare and equipped with emergency departments; therefore, this means that EMTALA almost covers all the hospitals in the United States.

The provision of EMTALA applies to all, not just those who are Medicare beneficiaries. They have the right to seek medical assistance through hospitals. EMTALA has certain guidelines when it comes to hospitals with dedicated emergency departments. Well, what does it mean when you say the emergency department?

  • The emergency department is licensed by the state to use as an emergency department
  • The emergency department is used by the public for providing emergency medical treatment
  • For all the patients visited the department in the whole calendar year, ⅓ of the visits must be composed of providing treatment for emergency medical situations on an urgent basis. 

However, there is an exception to the provision of this law, for example, private clinics, standalone medical laboratories, private doctors, or those specialty hospitals that are not equipped with emergency departments are not subjected to EMTALA and its provisions; therefore, they have the right to deny in treating patients, whatever their reasons are. This is because private doctors and small private clinics are just like small businesses, wherein if a patient does not pay for the treatment he/she receives, the doctors will not earn money. 

Here are some situations wherein private doctors and small private clinics can deny patients.

  • The doctor is too busy and unable to cater to new patients
  • The patient does not have the ability to pay the cost of the treatment
  • The doctor is not equipped to treat specific illnesses or condition
  • The doctor or the clinic is not affiliated with any medical insurance company either private or government
  • The patient is a malpractice lawyer

Other certain situations where a doctor may refuse to treat patients include:

  • The patient has not paid the bill
  • The patient is misbehaving and showed drug-addicting behavior
  • The patient is destructive

On the other hand, if you are the patient and you know that the hospital is governed by EMTALA, yet refuses to treat you and that refusal has caused your condition to worsen, you may contact a malpractice lawyer first before filing a lawsuit since the lawyer knows if you have good chances of winning the case. 

Here are some things you must know  as a patient’s right on how to handle this kind of situation: 

1. You Don’t Need to be Admitted at the Emergency Room

According to EMTALA, hospitals cannot deny patient treatment who seek emergency medical attention. You might be wondering if you have to go to the ER first before getting your treatment? Well, I don’t think so, because once you get in the hospital proper (governed by EMTALA) such as in the parking lot, driveway, sidewalk, or just within 250 yards through the main hospital building, you can receive your treatment.

2. What is an Emergency Medical Condition?

Your condition may be considered an emergency if you have severe symptoms that may put danger to your health, can cause severe impairment to your body, and can cause organ or body parts dysfunction. 

Emergency medical situations may also apply to pregnant women who are having contractions and may be due for labor. Therefore, it also applies in certain situations such as lack of time to transfer the pregnant woman before the delivery or transferring the pregnant woman that may threaten her health and the safety of the unborn baby.

The definition of an emergency medical condition is somehow broad; therefore, make sure that your condition lies in those situations. For example, people with sprained ankles will not be considered an emergency medical conditions under EMTALA, but a patient with a fractured bone may qualify since it can cause serious damage or it may dysfunction the body part with fracture, if not given medically treated right away.

Same goes for a pregnant woman who is not yet due for labor may not be qualified for the EMTALA, unless the pregnant woman has serious medical conditions that may put her and the baby’s life at risk.

3. EMTALA-Approved Hospitals Obligations

For patients who seek emergency medical care, the hospital has the right to conduct a proper medical examination to assess whether the patient has indeed emergency medical condition.

If the patient has been confirmed with an emergency medical condition, the hospital is required to provide treatment to stabilize the patient’s condition before they can transfer the patient to another hospital. It is necessary to keep the patient stable so that the hospital may assure that they are not liable if the patient’s condition worsens during the transfer to another hospital. 

In other cases, the hospital may transfer the patient without giving any stabilizing treatment unless the patient makes a written transfer request after the doctor is informed about the possible risks or the attending doctor issues a certificate that the benefit of transferring the patient to another hospital outweighs the possible risks.

On the other hand, if the hospital deems that the patient does not need immediate medical care, after running some medical examinations, the hospital is not obliged to cater to the patient regardless if the patient does not have any health insurance.

4. The hospital Cannot just Transfer a Patient Without any Stabilizing Treatment

Despite the fact that the hospital may transfer the patient without giving any stabilizing treatment, the hospital just cannot transfer the patient anywhere. To make the transfer legal, the hospital must attempt to make the patient medically stable as possible within the attending doctor’s capabilities. Hence, you may only consider the transfer as legal together with the patient’s medical records once the transfer hospital agreed to take the patient.

Can You Sue a Doctor or Hospital for Refusing Medical Treatment?

If you have been wrongfully denied for emergency treatment or dismissed from the hospital even though you meet the guideline of EMTALA for emergency patients, you may hire a malpractice lawyer to seek financial compensation from the hospital that denied you.

Your right for emergency medical treatment is not just a basic human right, but it is mandated and governed by the federal law, EMTALA. 

What Does EMTALA have to do with Malpractice/Medical Negligence to Patients?

1. It Covers Almost all Hospitals

Except for standalone clinics, private doctors, and small medical laboratories without emergency departments are not subjected to the provision of EMTALA. Hence, for hospitals affiliated with Medicare or Medicaid, they are mandated to abide by the provisions of EMTALA

2. EMTALA has Expanded Reach

Not just the emergency department, but you can also sue other departments in the hospital that denied to give emergency medical care.

3. You can Collect more Claim in EMTALA than In-State Claim

This is because they do not honor pain and suffering damages in most state malpractice laws; but with EMTALA, it can help you recover from these physical and psychological damages.

4. You can Still Sue the Hospital or Doctor after the Two-Year Period

After the malpractice or negligence incident, you will be given two years to sue the hospital or the doctor. Therefore, if the state claims a two-year period has passed, no worries since you can still sue the hospital or the doctor under the EMTALA within the two-year period.

Well, here are just some of the benefits of using EMTALA in regard to malpractice or medical negligence. You may check this site to know more information.

Therefore, you need to get a good malpractice lawyer who will cover all the laws and regulations, which can help you win the case.

Hence, by filing a malpractice lawsuit it can help you compensate from the following:

  • Lost wages
  • Out-of-pocket expenses due to denial from the hospital
  • Medical bills
  • Pain and suffering damages

However, these hospitals and doctors are covered by malpractice insurance companies, so that any malpractice claims raised by a patient will be defended by the lawyers working on that insurance company. Malpractice and medical negligence are complicated cases, which cost high-dollar fines if proven guilty.

Leave a Comment

Your email address will not be published. Required fields are marked *