Patients, families must be vigilant and aware of what they are signing before receiving emergency treatment
By Betty Long, RN
With any luck, you'll never have to accompany someone to the emergency room. But, in the unfortunate circumstance that you do, make sure to take your reading glasses.
Recently, a friend of mine briefly lost consciousness at work and was taken to the ER by fire rescue. I rode with her and upon arrival in the ER, nurses and physicians asked her several questions about her condition. Thankfully she was awake and alert, and answered easily.
And then the ER clerk arrived. Holding out a clipboard filled with paperwork, she quickly directed my friend to "sign your name and I'll make copies and bring them back." In my view, not providing any explanation of the paperwork or allowing any time for any discussion was inexcusable.
Amidst the stack of documents was a joint notice of privacy practices acknowledgement, a consents for treatment form, conditions of services form and a form titled "An Important Message from Medicare About Your Rights and a Patient's Responsibilities."
Let's face it. If you've been taken to the emergency room, chances are you need urgent medical attention and may not be as vigilant as you may need to be to fully comprehend what you are signing and agreeing to. If you are not able to sign the paperwork, that responsibility then falls to your family or the person who accompanied you.
Paperwork 101
Here is a primer in ER paperwork so that, whether you're a patient or loved one of a patient, you'll be ready for the ER clerks when they arrive:
* Joint notice of privacy practices acknowledgement. This document identifies how medical information may be used or disclosed, your rights to access and amend your medical information and request an accounting of disclosures of your medical information, your rights to complain if you believe your privacy rights have been violated and the hospital's responsibilities for maintaining the privacy of your medical information.
* Consent for treatment. This consent can include: consent to medical and surgical procedures; consent to be photographed, including acknowledging that the hospital is permitted to use cameras or other devices for patient monitoring; and consent to nursing care.
* Conditions of services. This lengthy document comprises multiple components, primarily financial responsibility - often with a phrase that reads "It is agreed and understood that regardless of any assigned benefits/monies (insurance), I, as the designated responsible party, am responsible for the total charges for services rendered."
In addition, this document authorizes the hospital to receive payment from any party or entity that may be responsible, and allows the hospital to share financial and clinical information with the insurance company, Medicare, Medicaid, any other person or entity that may be responsible for paying a portion of the hospital bill, accrediting, regulating and state agencies, and any other hospital, nursing home or other health care institution in which the patient is provided treatment.
The conditions of services form also explains that the hospital will not be liable for the loss of/damage to any money, jewelry, documents, dentures, eyeglasses, hearing aids, or prosthetics unless placed in the hospital safe. And only then, their liability may be limited to a certain dollar amount.
* Medicare Patient's Assignment of Benefits and Release of Information. This explains that the patient is certifying that the information given by them when applying for Medicare was correct. By signing, the patient also understands that he or she is "responsible for any remaining balance not covered by Medicare or other insurance."
* Financial responsibility by person other than the patient or the patient's legal representative. This form generally states, "I agree to accept financial responsibility for services rendered to the patient and to accept the terms of the Financial Agreement and Assignment of Benefits to Hospital and Hospital-Based Physicians. If you are not related to the patient and do not want to accept financial responsibility, do not sign this."
* "Important Message from Medicare About Your Rights." This outlines the recourse patients have if they have concerns about the quality of care. It also provides guidance and phone numbers for patients who, in their judgment, feel that they are being discharged prematurely.
* Patient responsibilities. This details out what the hospital expects of the patient in terms of behavior, providing information and communicating with the hospital staff.
Be a smart consumer
There have been multiple instances when we have been asked to intervene on behalf of patients who had outstanding balances for services rendered after being admitted through the ER. Very few of these patients, like my friend, had read the paperwork.
Be smart health care consumers. If you have insurance, know your benefits. When interacting with hospitals or physician offices, read before you sign. Understand what you are consenting to. Ask questions when you don't understand.
Heading to the ER or being admitted to the hospital can be a time of great physical and emotional stress. Don't let it lead to financial stress, too.
Contributing Editor Betty Long is a registered nurse and founder of Guardian Nurses Healthcare Advocates, a health care advocacy firm that has helped thousands of patients navigate the health care system and saved millions of dollars in health care costs.