A friend of mine recently accompanied a neighbor who does not have any savings or any health insurance to the emergency room. Before they went, MaGreen and I researched and talked to friends about what there options were. I have recorded what I learned in the post below. Some might use these tactics to help friends, family, co-workers, or your own paid help (maid, nanny, etc.). You might need this information for yourself, but I have written it as if a person were helping a friend in the City of Houston. The same basic rules apply across the United States for everybody including Spanish speakers and those without immigration papers. (If you live in Sweden, Canada, or the UK, just smile smugly for having guaranteed healthcare and move on to the next post.) Please note that I am not advising and advocating anything, I'm just describing what I learned.
Non-Urgent Care
If your friend’s illness is not extreme, visit a walk-in clinic. These clinics go by many names and are run by many organizations throughout the area. All residents of Harris County can call Ask-A-Nurse at 713 633 2255. They have bilingual registered nurses who can help you and your friend figure out the best option for care. Also for those who live in Harris County, there is a free healthcare program known as the Gold Card. Your friend does not need papers to qualify, but proof of living in Harris County is required. Visit this link for more information. With this card, your friend can visit doctors at the public hospitals and clinics for free or a very low fee.
Urgent Care
If your friend has an urgent need for care – a broken leg, extreme stomach pain, an open wound – you should go to a hospital Emergency Room. The ER must accept her as a patient by law. Period. She should be prepared to wait 24 hours in the waiting room. (If you go, cancel all your appointments.) Only the most extreme cases are seen immediately. Here are the steps you should follow.
1) Choosing a hospital
Ben Taub Hospital is the public hospital. The nurses and doctors are accustomed to uninsured patients, but the wait is long because of overcrowding. Private hospitals such as St. Luke’s hospital have shorter waits, but if your friend does not speak English well she ought to take someone who does with her.
2) Giving a Different Name, Phone Number, and Address
Before she goes to the hospital, the friend might think of a different name, phone number, and address that are easy to remember. Jane Thompson instead of Jane Williams. She might change the last digit of the phone number. The friend would agree on the plan. When she enters the ER, she would explain her need at the big desk at the front. They will ask for her name. She would give them the one decided on earlier. Then she will have to wait. If there is a big crash on the highway after she arrives, the wait might suddenly double. At some point, they will call her up and ask for her information. She would give the made up name, number, and address. When they ask for ID, she would just say she does not have any. They might ask two or three times for different forms of ID, but they will quickly give up.
3) Ask for Translation
If your friend does not speak English well, she should still have the benefit of understanding what the doctor says. Ask for a translator if you are with her. Diagnosis is a subtle art. And your friend must understand the doctor’s instructions. Hospitals usually have a list of people who can help with various languages, even ones you might not expect like Hmong.
4) Discharge
The ER might be your friend’s one chance to receive expensive tests like blood analysis and CAT scans. Ask for a copy of the medical record so your friend can show it to the next doctor she visits. If your friend needs a prescription drug and you feel that you can trust your doctor, the doctor might be asked to write it out using your friend’s real name. When you leave, the hospital might ask for contact information again or try to set up a payment plan. Your friend would keep giving the new name she chose. If you are with her and they ask for your name, being prepared to make up a new name for yourself too might be necessary. Your friend may leave the hospital without being bothered at all.
5) Follow-up
The most challenging step will probably be following up on the care your friend received in the ER. Again, the Gold Card might be the best option. Or maybe you have doctor friends who can help out.
Good luck!
Friday, January 11, 2008
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7 comments:
Hi GreenDaddy:
I worked in health insurance for about 10 years. It's been 5 years since then, but I think I can still comment in a knowledgeable way.
ERs must accept all patients for assessment and stabilization. They are not required to do (relatively) advanced diagnostic or treatment procedures. Essentially all the law says is that you cannot be refused to be seen. You can be refused certain levels of care without a demonstrable ability to pay -- though hospitals that see a lot of indigent/uninsured patients, like public hospitals, may not refuse that.
While I think I understand the reasoning behind someone giving a false name and contact information because of payment or immigration concerns, I have two thoughts:
One, it's fraud, because you are trying to get something for free. I won't go into a long discussion of society's responsibility to care for people in need, but on the face of it, please remember that at root, this is fraud. Be sure you are comfortable with doing something like this, because of true need.
Two, giving out a false address and phone number has repercussions on other people. I get numerous collection calls for someone who clearly gave out our phone number to her creditors. Just something to consider as well, that your actions will affect others.
If the patient in question is a legal citizen but has no insurance, I think there's a huge moral dilemma here about trying to get ER care for free. Hospitals would much rather get some money than none, and will work with the person to develop a payment plan. Perhaps it's worth it if the patient is illegal, but I'm not sure.
I agree with your point about the hazards of this tactic. My friend and the neighbor had to weigh out the need with the possible repercussions. (I hope they picked a phone number and address that didn't belong to anybody.)
When my friend described the scene in the ER, it didn't sound like there were many affluent people there. This tactic is for people with incomes that are so low that even a discounted ER bill would be impossible to pay. The real huge moral problem is that one of the wealthiest societies in the history of the world does not provide access to basic healthcare except through this absurd back door.
Haha. Wow, the downfall of america.
Thanks for sharing this. The system is flawed and falling down. But there are times when worrying about risk and repercussions is a luxury. This post might be a life-line for someone who is in need of medical care but is afraid to access it.
NZ
GreenDaddy, you're right about the bigger moral problem. I think the US has forgotten how to think about what government should be for. We think nothing of paying taxes that go directly toward paving public roads, because we all need roads, right? So why are people so unwilling to even consider the idea of providing healthcare for everyone? I understand the hesitation based on the problems of socialized medicine in other countries. But as you pointed out, we have the most resources to figure it out!
And these days, you won't see many affluent people in the ER, because it's mostly going to be people without insurance who are forced to use the ER for what should be basic care, or who have to wait until their problem gets so bad that it warrants an ER visit because they couldn't get preventive care.
heniserk, socialised health care may not be perfect, but it's significantly better than the 'care' many Americans get.
I'm very very grateful that my fellow Australians (of all political stripes) agree that we should all be able to get healthcare without getting our wallets out first.
As for socialized medicine, it saved MY life, so I'm all for it.
I was in Spain studying in Salamanca when I contracted a mysterious illness that would not abate. When my fevers struck the high mercury levels, I was finally rushed to the Universidad Hospital, a teaching hospital. I was admitted and treated there for nine days. I did not have to pay a cent. Thank you, Spain.
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