In need of an urgent procedure - resources for Patients' Rights?
March 22, 2015 4:56 PM   Subscribe

She's uninsured and pretty weak, but told she needs the operation in 30 days or her life is at risk. How do we get a hospital to take her on?

My brother's partner is unemployed and does not have medical insurance (do not get me started). She delayed seeking medical care for a troublesome condition until she landed in the ER this week in extremely serious condition. She was told by the ER that she will require a certain (normally routine) operation within 30 days or she could die. She was discharged two days ago.

She is in a very weak condition, and my brother says that so far, the hospitals he has called are reluctant to take the risk operating on her in her current state. He is calling around to find somewhere to take her, but he feels they're being brushed off ("we're not taking new patients" "we have no openings in the next two months.") I do not know precisely how he has been communicating her circumstances in these calls - whether he is telling them that she has a life-threatening condition nor whether he is telling them about her lack of insurance. I'm a little appalled that they were not given any further guidance beyond essentially a phone book for next steps when she was discharged.

I would like to help them better understand her rights as a patient. I don't know where to begin looking. They are in Texas. Do you have pointers for resources that can help us answer some basic questions: in case of a life-threatening condition, can hospitals deny her care? How are these things handled for the unemployed and uninsured? (They have some money to put towards this, but it won't be enough). Is there a script my brother should stick to when calling hospitals?

Resources or direct answers to those questions gratefully received!
posted by oneaday to Health & Fitness (13 answers total)
I don't have specific suggestions, but googling "how to pay for surgery without insurance" brings up a lot of information.
posted by vitabellosi at 5:04 PM on March 22, 2015

If there is an immediately life threatening condition and she comes to the ER, she cannot be turned away. This is guaranteed by a law called EMTALA - the anti-patient-dumping act. If you shared what the routine condition is I might be able to offer further advice.
posted by treehorn+bunny at 5:11 PM on March 22, 2015 [8 favorites]

And regarding how these things are handled, usually the hospital will have a financial counselor who will start an application for Medicaid as soon as the patient comes in, so that they can get covered ASAP. my understanding is that if they complete and submit the application there may be retroactive coverage. She needs to talk to the financial counselor at the hospital right away.
posted by treehorn+bunny at 5:15 PM on March 22, 2015 [5 favorites]

Does she have a family doctor? Part of a family doctor's job is to advocate for the patient with specialists and coordinate care, even if the condition is not something they can treat themselves. If she doesn't have a family doctor, does your brother? Do you? If either of you do, consider calling your own doctor and asking them to take on your aunt, given the urgent circumstances.

My own family doctor has provided one-time special circumstances care to a relative of mine though she wasn't taking new patients and the relative was not going to be her long term patient. We were able to get that care for our relative because of the family doctor's relationship with me and my family. Leverage your own relationship with your own doctor if you can -- even if they can't take your sister-in-law on, they can probably advise. They have knowledge of the workings of the system in your area.
posted by If only I had a penguin... at 5:19 PM on March 22, 2015

Response by poster: (Jumping in to answer treehorn + bunny's question in case it helps: a hysterectomy will be required, they need to remove a large mass simultaneously.)
posted by oneaday at 5:22 PM on March 22, 2015

Contact Planned Parenthood.
posted by If only I had a penguin... at 5:25 PM on March 22, 2015 [13 favorites]

What county is she in in Texas? Indigent health care in Texas has a county hospital program. In Harris (city of Houston) it's Ben Taub, in Tarrant (Ft. Worth) it's John Petersmith hospital, in Dallas it's Parkland. Start here.
posted by Grumpy old geek at 5:58 PM on March 22, 2015 [1 favorite]

U.S. hospitals that participate in Medicare are required to stabilize patients with emergency medical conditions. Unfortunately, additional care (such as surgery) is often needed, and the requirements do not extend to providing such care, even though it may be life-saving.

Grumpy old geek's answer is what I came in to say. Although it varies by county and district, Texans pay some local tax to support indigent health care.

Calling hospitals is probably not the best route to finding help. She needs to find a physician associated with a hospital connected to the indigent health care program. If she does not have a primary care physician who can refer her, going to a federally qualified health center could result in a referral to get her the help she needs.
posted by Snerd at 6:19 PM on March 22, 2015 [3 favorites]

As far as paying for the operation, every hospital assumes that some portion of their patient revenue will be uncollectible. It's a cost of doing business in a country that has far from universal health insurance coverage. For non-profit hospitals (the majority), it's actually part of the reason that don't have to pay income taxes; charity care is part of the benefit to the community that they provide in lieu of taxes.

The hospital will have financial counselors who will be able to figure out if your brother's partner is eligible for Medicaid or other programs, and there is a strong possibility that she will get a charity care write off for part of the bill, if she and your brother are clear that they're unemployed, uninsured and don't have insurance. They will also likely be able to work out some kind of reasonable payment plan, since the hospital would rather get something than nothing. \

Caveat: I am in a health systems management grad program, but I am not your health system manager and there will obviously be wide variation in how the hospital handles these situations and how many phone calls and working through red tape will be required.
posted by MadamM at 7:22 PM on March 22, 2015

If she's in Harris County, yes, start at Ben Taub, and they will help her enroll in the Harris County Hospital District Gold Card system.
MeMail me if you need more information.
posted by MexicanYenta at 8:42 PM on March 22, 2015 [2 favorites]

Here in VA, indigent care hospitals also have some form of patient financial screening, in that once you've proven unemployment, low pay, etc., you are deemed eligible for a 20%, 50%, and even 100% discount.

YSMV (your state may vary).
posted by kuanes at 8:06 AM on March 23, 2015

I presume they gave her a blood transfusion? If her iron gets too low, they may not be able to operate without one.
posted by serena15221 at 12:53 PM on March 23, 2015

the hospitals he has called are reluctant to take the risk operating on her in her current state. He is calling around to find somewhere to take her, but he feels they're being brushed off ("we're not taking new patients" "we have no openings in the next two months."

Sorry, I don't have anything to add with the specifics of a hysterectomy, except that the place to start is most likely a women's health clinic attached to an academic tertiary care center (which I assume is pretty much the same as what others are referring to as an 'indigent care hospital' - it's a big hospital with residency training programs for doctors where patients who are uninsured or on Medicare/Medicaid can get taken care of). The women's health clinic will be under the auspices of the OB/GYN department, but she may also need a general surgeon depending on what the mass is.

I quoted the passage above because I wanted to highlight two things:
- One doesn't generally go about getting a doctor by "calling hospitals" (who's he talking to? The hospital operator? The primary care office? Department of Surgery?) - he needs to call the number for the clinic where he wants to get her an appointment and make one. Tell them it's an urgent emergency department follow up rather than a routine visit. Routine appointments can be booked up, but offices for services like surgeons and primary care keep urgent/"sick appointments" available for patients who need them. He also needs to ensure he is calling clinics like the ones I mentioned above - ones that take Medicaid patients. Many places just simply don't take Medicaid. Often a big tertiary care center will have a referral hotline that can tell you who is taking Medicaid patients so that you don't have to waste your time calling every different office.
- The "not willing to take the risk" part doesn't align with the "not taking new patients part" ("not taking new patients" is for routine, non-urgent issues while "not willing to take the risk" is for patients who are dying and the alternative is hospice, or who need intensive medical care to optimize their condition prior to surgery). If he's talking to secretaries on the phone, and she hasn't seen any other doctor aside from the emergency department doctor, then he really should have no idea yet whether a surgeon thinks the risk of surgery is worth it for her. Basically, if she's got other medical problems aside from this hysterectomy/mass issue, which it sounds like she does, she likely needs to see a medical doctor in addition to a surgical one, and don't delay seeing one for the other - work on getting both appointments simultaneously.
- Also just wanted to add that a lot of hospitals will let patients walk in and meet with the financial counselor without even an appointment. So that's something that might be able to be arranged very quickly.

I presume they gave her a blood transfusion? If her iron gets too low, they may not be able to operate without one.
I don't think it's worth giving a detailed explanation about why this advice isn't relevant to your question, let's just leave it at the fact that this question doesn't have nearly enough information in it for medical advice to be discussed, nor is this case a good one for lay persons to give internet medical advice on either way.
posted by treehorn+bunny at 9:36 AM on March 24, 2015

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