Copay collection dilemma
Most insurance companies require a copay for different types of appointments, including ER visits. This seems reasonable enough, and most of the rules, depending on the particular policy make sense. But now that the hospital I work in attempts to collect these copays before discharge, the inequalities of our health care system are becoming more clear to me.
Every ER has what staff call "regulars." These patients come in day after day, sometimes more than once a day for something-usually pain medication. Other regulars seek food, shelter or want human companionship. And still more come in under the influence of drugs or alcohol. They do not have a copay because they are uninsured.
Now, take the family who has brought their son in after he fell off the swing. It's swollen, bruised and painful to the touch. It may be broken or sprained. Most doctor's offices do not have X-ray machines or the ability to fix a broken bone. This family needs to be in the ER. They will be asked for a copay prior to discharge.
Why does this bother me? Well, for one, I see so many parents stressed because they can't pay the copay. They weren't planning on visiting the ER, unlike a doctor's visit that is scheduled. And many didn't know that their insurance company requires a copay for visits to the ER. They assumed that because they have insurance, everything is covered. Now they are starting to worry that none or little of the visit may be covered. Forget the broken kid...how are they going to pay for this?
And it delays discharge. Everything about the ER is waiting, something many people don't realize. During busy times, everyone waits to be triaged, and then to be seen, and then to be treated. After treatment, we discharge the patient home, if appropriate. Prior to discharge, however, I now have to wait for the copay to be collected. Again, the families wait.
On the hand, if people knew they had a copay to visit the ER would they take it more seriously? Would they begin to redefine reasons to come in? I doubt it. The ones who abuse the system rarely have to pay for it. And the purpose of the copay is not punishment, but a way to help offset the cost of care delivered. Collecting copays is one way for our department to increase revenue. And I am hearing that it's working.
I think what bothers me is the fact that I am a nurse, not a cashier. No, I am not responsible for the exchange of money, but I do have to let the families know why they are waiting. And the look of additional distress on their faces rips me to shreds. The ER, for most is not a pleasant experience and now they have a financial burden to bear, on top of a health related one. It does not make sense to me, especially when I see so many people flow in and out of that ER without needing to fork over one dime.
I wonder, how many other ERs collect copays? And how does it work for them? How do you feel about it? And if you are a patient, do you expect to be charged while still in the department? I'd love to hear thoughts on the subject.