Emergency Medical Treatment and Labor Act

Florida emergency care: know your rights if you don't have Florida health insurance!

Did you know that even if you are not covered by a Florida health insurance plan you are covered in an "emergency" situation? Know what your rights are when it comes to Emergency Medical Treatment when you are sick or injured.

This Act prohibits participating hospitals and emergency medical service providers from a practice commonly referred to as "patient dumping" whereby patients taken it with no money or health insurance are stabilized and then "dumped" or released from their care into a County hospital or clinic. Most hospitals in the U.S., those participating with Medicare are governed by this law.

What is EMTALA?

The Emergency Medical Treatment and Active Labor Act is a Federal law that was passed in 1986 that governs how a patient may be refused treatment or transferred from one hospital to another when he is in an unstable medical condition.

The essential provisions of the statute are as follows:

Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition". If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.

What the Law does:

imposes an affirmative obligation on the part of the hospital to provide a medical screening examination to determine whether an "emergency medical condition" exists;
imposes restrictions on transfers of persons who exhibit an "emergency medical condition" or are in active labor, which restrictions may or may not be limited to transfers made for economic reasons;
imposes an affirmative duty to institute treatment if an "emergency medical condition" does exist.

EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, and it is sometimes referred to as "the COBRA Law". In fact, a number of different laws come under that general name. Another very familiar provision, also referred to under the COBRA name, is the statute governing continuation of medical insurance benefits after termination of employment.

The purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity hospitals" or "county hospitals" because they are unable to pay or are covered under the Medicare or Medicaid programs.

What is an "emergency medical situation"?

The definition provided under the statute is:

"A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in -- placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part, or

"With respect to a pregnant woman who is having contractions --
that there is inadequate time to effect a safe transfer to another hospital before delivery, or that the transfer may pose a threat to the health or safety of the woman or her unborn child."

Can the hospital inquire about the patient's ability to pay?

Yes, but timing is everything. The statute does not prohibit an inquiry into availability of medical insurance; it does provide that neither examination nor treatment may be delayed to make the inquiry. So in other words, yes they can ask you whether you have health insurance but they are not allowed to prevent or delay the performance of a medical screening evaluation or stabilizing treatment once it is determined that an emergency medical condition exists. The key is that an Emergency medical situation must exist.

The Official U.S. Government EMTALA site

So what does this all mean?

Well to put it simply, yes you are guaranteed a certain level of treatment in an emergency situation even if you don't have a Florida health insurance plan. They will stabilize you and follow medical protocol when it comes to treating your condition and then release you. Follow up care is not mandated. The intent of this Law is to cover indigents and other economically distressed people who have fallen on hard times. This is not for people who decided to take a trip to Rio instead of buying health insurance. Insurance is only sold to people who are "healthy" and who the insurance company believes have a better then average chance of not needing huge benefits. The problem we all have is that not everyone manages to stay healthy.