How do ambulances/ERs deal with billing unconscious patients?

[NinjaChick]

I don't mean permanent comatose patients, I mean people who are taken to the ER/treated while unconscious, under the theory of implied consent.

Hypothetical A: John Doe is out for a jog or a bicycle ride or whatever. He gets hit by a car/trips and falls/a coconut hits him on the head/whatever. He's rendered unconscious, a bystander calls 911. An ambulance comes and takes John Doe to the local ER. Regardless of what happens then, he's looking at a minimum of a hundred bucks (if he's insured) for the visit. But since he was brought there while unconscious, he obviously did not nor could not have actually consented to treatment. How is it that he can't just say, "Sorry, I didn't ask for nor consent to treatment" and avoid being billed?

Hypothetical B: Introducing another issue: John Doe takes a whole bottle of aspirin and washes it down with a lot of booze. He's previously gotten his affairs in order, he's left a note - it's obvious he wants to die. A relative stops by unannounced, peers in the window, calls ambulance, and John is again taken and treated while unconscious. In this case it's fairly obvious that the person would not consent to treatment if they could comment on it, but the hospital nonetheless pumps his stomach and revives him. John rejoins the living with a few grand in medical debt for treatment he did not want.

In either of these situations, what legal standing is there for billing the person? How would it be any different from, say, Pizza Hut showing up at my door with three pizzas and demanding that I pay them, under the assumption that I'm a college student and therefore must want pizza? Obviously, that's a bit of hyperbole, but hopefully it explains what I'm trying to ask.

[Attack from the 3rd dimension]

Well, here in the frozen socialist Northlands, we just....don't bill them, 'cause its socialist medicine.

Back when I lived in 'Merica, my uninsured friends would just reel off a string of numbers and say it was their Blue Cross number, but that was back when computers were primitive. Now I think ERs and Hospitals generally take it as a loss if there's no insurance, and they've been unable to nag the money out of the patient.

[USCDiver]

In both cases, the patient (or family) would be sent a bill after their hospital stay. Emergency consent is always implied in such cases. We assume the patient wants to continue living unless we see a DNR order or family with Power of Attorney who refuses treatment. After the fact, the patient (or family) can always refuse to pay the bill at which time it becomes the same as any other bill one refuses to pay.

On average 'most' patients with no insurance will refuse to pay their bill. In my current ER, we collect an average of $7 for every 'self-pay' patient we see.

[Mr. Slant]

In an emergency situation, I've always been tempted to see what would happen if I just kind of neglected to ID myself and/or refused to ID myself for the ER/ambulance staff.
"For security reasons, I'm not going to answer that question. Once this is no longer an emergency, I'll be leaving without answering."
Anyone ever done that?

[USCDiver]

In the case of patients with no identification, they are often initially registered as 'unknown'. Most cases are the result of trauma or severe medical illness which would require admission and the patient's identity is determined after the fact. Mostly by contacting family members. Someone somewhere knows who you are.

[NinjaChick]

Originally Posted by USCDiver

In both cases, the patient (or family) would be sent a bill after their hospital stay. Emergency consent is always implied in such cases. We assume the patient wants to continue living unless we see a DNR order or family with Power of Attorney who refuses treatment. After the fact, the patient (or family) can always refuse to pay the bill at which time it becomes the same as any other bill one refuses to pay.

On average 'most' patients with no insurance will refuse to pay their bill. In my current ER, we collect an average of $7 for every 'self-pay' patient we see.

That's what I figured. But how is it legally justified? I can't imagine any other situation where people are allowed to do things wholly without consent and then hold the person financially responsible.

And I'd think that in a glaringly obvious suicide attempt, it may be treated differently. Is this not the case?

[Little Cloud]

What USCDiver said.

Mr. Slant would have his emergency treatment and (after all treatment was completed) would be asked to pay on the spot if he was unwilling to give his identity or billing information. If he refused to do either, the police would be called and he would be charged with theft of services.

[Little Cloud]

Where I live, suicide is against the law so that is not a factor in the decision to treat.

[USCDiver]

Originally Posted by NinjaChick

That's what I figured. But how is it legally justified? I can't imagine any other situation where people are allowed to do things wholly without consent and then hold the person financially responsible.

And I'd think that in a glaringly obvious suicide attempt, it may be treated differently. Is this not the case?

I'm not clear on all of the laws, but it doesn't have to be legally justified. The pursuit of life is held to be self-evident (see the Declaration of Independence). I'm partially joking here, but it is assumed. The reason you can't imagine any other situation is because there aren't any that are applicable.

As for the case of 'glaringly obvious suicide attempt', suicidal ideation is considered to be part of mental illness which in that particular case would render the patient unable to make health care decisions or in fact to give consent for refusal.

[Mr. Slant]

Originally Posted by Little Cloud

What USCDiver said.

Mr. Slant would have his emergency treatment and (after all treatment was completed) would be asked to pay on the spot if he was unwilling to give his identity or billing information. If he refused to do either, the police would be called and he would be charged with theft of services.

Thanks. I'd never had an answer to that inquiry before.
I'll take the phrase "theft of services" and commence with the Googling.
For kicks, I'll try to determine if the scenario changes if you come in unconscious..

[St. Urho]

Originally Posted by NinjaChick

That's what I figured. But how is it legally justified? I can't imagine any other situation where people are allowed to do things wholly without consent and then hold the person financially responsible.

This came up in another thread a while back. Gfactor, as usual, had the legal bases covered:

Originally Posted by Gfactor

Instead it's part of the doctrine of necessaries. You are liable for necessary items (food, medical care) which are provided to you in some cases. E.g., K.A.L. v. Southern Medical Business Services, http://www.birminghambar.org/data/S.../2011074_17.htm (Ala. Ct. Civ. App. 2003) (prisoner who attempted suicide was liable for necessary medical treatment despite lack of consent to treatment).

As far as the practicalities of actually billing someone, we usually get a "face sheet" from the hospital. It it's known, this usually has name, date of birth, address, next of kin, insurance info, etc. It also has a patient ID number. For a John Doe, we'll get a face sheet that says that and our billing department follows up with the hospital when they figure out an actual identity. Then they bill the patient or insurance, as the case may be.

ETA: It's not "wholly without consent," either. If someone is unconscious or otherwise impaired, we have implied consent to treat/transport them.

St. Urho
Paramedic

[Desert Nomad]

So I don't have insurance in the US... If I am out jogging under coconut trees, should I carry no ID (or perhaps just a foreign language ID?

FWIW I was able to board a flight in the US using a European city's transit pass as ID... good enough for TSA, good enough for hospitals.

[racer72]

The county I live in would pay for the ambulance rides, you would be transported by a Medic One ambulance, not a private ambulance company. It's included in the property taxes everyone pays as part of the county 911 emergency services levy.

[alphaboi867]

Originally Posted by Little Cloud

What USCDiver said.

Mr. Slant would have his emergency treatment and (after all treatment was completed) would be asked to pay on the spot if he was unwilling to give his identity or billing information. If he refused to do either, the police would be called and he would be charged with theft of services.

And the DA would probally tell the hospital to file a civil suit and be done with it.

[St. Urho]

Originally Posted by racer72

The county I live in would pay for the ambulance rides, you would be transported by a Medic One ambulance, not a private ambulance company. It's included in the property taxes everyone pays as part of the county 911 emergency services levy.

I just wanted to point out that many, if not most, public ambulance services bill for services. It's not just private ambulance companies.

[gotpasswords]

Originally Posted by St. Urho

I just wanted to point out that many, if not most, public ambulance services bill for services. It's not just private ambulance companies.

Adding to the confusion, a lot of municipalities have contracted out ambulance service to private companies, rather than maintaining and staffing their own. In my county, for example, you'll be carted off by American Medical Response, who claims to be the largest private ambulance company in the US.

[St. Urho]

AMR is the largest private ambulance company in the U.S. Whether or not that's a good thing is open to debate. They're commonly called the Evil Empire in EMS circles...

[kunilou]

Originally Posted by NinjaChick

And I'd think that in a glaringly obvious suicide attempt, it may be treated differently. Is this not the case?

Not in some jurisdictions, at least. I knew an EMT who was told very plainly that it was his job as a first responder to get an emergency case to the hospital. It didn't matter whether it was an attempted suicide or an old person whose family wanted to just let the victim die (if they just wanted to let the victim die, why did they call 911?) No exceptions, no judgment calls.

[BiblioCat]

Originally Posted by kunilou

...or an old person whose family wanted to just let the victim die (if they just wanted to let the victim die, why did they call 911?) No exceptions, no judgment calls.

If there is a DNR involved, we can't do anything. Yes, people freak out and call 911 when Grandma looks like she's dying, but if she has a legal DNR, we can't touch the patient.

[Boozahol Squid, P.I.]

In North Carolina, we don't need explicit consent for emergency treatment. We also bill for all ltreatment delivered. If a patient can be identified, a bill will be sent to his insurance company (if we can determine and verify his insured status) or to his home address. If we can't, the hospital eats the charges.

[St. Urho]

Originally Posted by NinjaChick

And I'd think that in a glaringly obvious suicide attempt, it may be treated differently. Is this not the case?

Can you elaborate on this? I'm not sure exactly what you're talking about.

Originally Posted by BiblioCat

If there is a DNR involved, we can't do anything. Yes, people freak out and call 911 when Grandma looks like she's dying, but if she has a legal DNR, we can't touch the patient.

The DNR only kicks in once they're dead. It gets tricky when they're only mostly dead (or don't have any loose change).

[Cartooniverse]

--snerk-- loose change--snerk--

Retired NY EMT chiming in. Back to the OP. Consent. I wish I'd not given away my Brady Books- the EMT course manuals. Basically, it comes down to this.

If you are unconscious, any emergency provider moves ahead rendering care under the reasonable assumption that had you BEEN conscious, you would have consented. Suicide notes are a bitch. I did a few suicide attempt calls. In one case, there was indeed a note. The patient was semi-conscious. We rendered aid and transported.

I believe it is called "Implied Consent". Suicide notes aside, one always assumes that the unconscious or incapacitated patient would want treatment.

The DNR issue has been addressed in other threads, I know it has. Can't FIND em. Know they exist.

Cartooniverse

[BiblioCat]

Originally Posted by Cartooniverse

I believe it is called "Implied Consent".

Yep, that's it. I just did my re-cert, and Implied Consent means you are allowed to treat and transport a person who has attempted suicide, unless there is an obvious mortal injury, like a gunshot wound to the head.
Sometimes the phrase 'Duty To Act' is used. You come across someone who is injured, and you have a Duty To Act; in other words, you have to help.



::: also laughing at the 'loose change' comment:::