Emergency Health Care & Child Birth, even if you are Uninsured

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Authored By: Legal Aid Services of Oklahoma, Inc.

FAQ

Can I get health care for an emergency or for child birth if I am uninsured and cannot pay?

Possibly, under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986.

If you have a medical emergency or you are a woman in active labor, you may have a right to be treated at a hospital emergency room.

The hospital may bill you later. But they cannot turn you away just because you are uninsured or cannot pay.

They cannot treat you differently than they treat other patients with similar emergency conditions.

What is the first thing a hospital must do when I go to the emergency room?

When you go to the emergency room, the hospital must first screen you to see if you have a medical emergency or if you are a woman in active labor. 42 USC 1395dd(a).

The hospital must screen you as far as it has the capability to do so. 42 USC 1395dd(a).

The screening must be done by a doctor or someone who is qualified to do the screening. 42 CFR 489.24(a)(i).

The hospital may not delay the screening to ask you about whether you can pay or have insurance. 42 CFR 489.24(d)(4)(i).

If you do not have a medical emergency and you are not a woman in active labor, the hospital is not required to treat you further.

When must a hospital treat me?

The hospital must treat you if:

  • You have a medical emergency; or
  • You are a woman in active labor;

AND

  • The hospital is covered by EMTALA;
  • You go to the emergency room; and
  • The hospital cannot transfer you.

The hospital may not delay treating you in order to ask about your insurance or ability to pay. 42 CFR 489.24(d)(4)(i).

Before they treat you they will screen you to see if you have a medical emergency or are in active labor. 42 USC 1395dd(a).

What is a "medical emergency"?

"Medical emergency" means that:

  • Your symptoms are so bad that, without medical treatment:
    • Your health will be in serious risk;
    • Your bodily functions may be seriously impaired; or
    • One of your organs or body parts may be seriously impaired;

OR

  • You are a woman in active labor.

You can read the text of this rule at 42 USC 1395dd(e)(1).

What does "active labor" mean?

"Active labor" means that:

  • You are having contractions;

AND

  • You cannot be transferred to another hospital before you have the baby;
  • A transfer might risk your health or safety; or
  • A transfer might risk the health or safety of your unborn child.

You can read the text of this rule at 42 USC 1395dd(e)(1)(B).

What if I do not have a medical emergency or I am not in active labor?
If you do not have a medical emergency, or you are not in active labor, the hospital does not have to treat you.
What hospitals does EMTALA cover?

EMTALA covers only hospitals that:

This means it applies to most hospitals in the U.S.

What if I am picked up by an ambulance, or I don't go to the emergency room?

You may still have the same right to be treated.

EMTALA has a broad definition of "go to the emergency room."

To "go to the emergency room" might also mean that:

  • You go to the hospital and ask for emergency treatment;
  • You go to the hospital and it is obvious that you need emergency treatment; or
  • You are taken to the hospital by an ambulance.

These are not the only ways that you can "go to the emergency room." It depends on the facts of your case. But if possible, you should go to the emergency room itself.

You can read the text of this rule at 42 CFR 489.24(b)("Comes to the emergency department means...").

When can the hospital transfer me?

To "transfer" you means that the hospital moves you outside of its building. You might be transferred to another medical facility. Or you might be discharged to go home. 42 USC 1395dd(e)(4).

The hospital can transfer you after you are stable.

Before you are stable, they can transfer you only if:

  • You are as stable as the hospital can get you;
  • You agree to the transfer after you are told about the pros and cons of the transfer and you sign a written agreement;
    • Or a doctor says that it is medically better to transfer you than to not transfer you;
    • Or if a doctor is not in the emergency room, another qualified person talks with a doctor and says that it is medically better to transfer you than to not transfer you;
  • The receiving hospital:
    • Will be able to treat you (and your unborn child) properly; and
    • Has agreed to accept you for treatment;
  • The hospital also sends all of the medical records about your emergency condition;

AND

  • You are transferred in a way that is appropriate for your medical condition.

You can read the text of this rule at 42 USC 1395dd(c).

What treatment will I get?

Under EMTALA, if the hospital cannot transfer you, they must treat you until you are "stable." 42 USC 1395dd(b)(1).

"Stable" means:

  • If you had a medical emergency, that your health is not likely to get worse if they transfer you to another facility; or
  • If you were a woman in labor, that you have delivered the baby and the placenta. 42 USC 1395dd(e)(3)(B).

Once you are stable, the hospital may transfer you, admit you, or discharge you.

The hospital does not have to cure you or do everything to make you better. The hospital just has to make sure, to the best of their ability, that you do not get worse.

How might a hospital violate EMTALA?

A hospital might violate EMTALA in many ways.

Here are some examples that might violate EMTALA:

  • Not screening you like other patients with the same or similar condition;
  • Delaying or denying you a screening by asking you payment information before screening;
  • Refusing or failing to treat you to the extent the hospital is able;
  • Failing to inform you of the risks and benefits of treatment or transfer;
  • Not giving you life support during transfer if needed; or
  • Refusing to accept a transfer.
What can I do if the hospital violates EMTALA?

If you think a hospital has violated EMTALA, you might talk with an attorney or with the proper government agency. The hospital might be fined. If you were harmed, you might also be able to sue.

You should contact someone as soon as possible. Many legal matters have strict time limits. For example, a suit for injury under EMTALA must be filed within two years after the violation. 42 USC 1395dd(d)(2)(C).

To find out where to call or visit Legal Aid, visit our contacts page:

Phone numbers (Link: http://www.legalaidok.org/RTF1.cfm?pagename=Call%20the%20Hotline)

Local offices (Link: http://www.legalaidok.org/RTF1.cfm?pagename=Contact%20Us)

The following groups can help you find an attorney to talk with:

Oklahoma Bar Association (Link: http://www.oklahomafindalawyer.com/find)

Tulsa County Bar Association (Link: http://www.tulsabar.com/shell.asp?pg=13)

The following agencies take EMTALA complaints:

U.S. Department of Health and Human Services
Centers for Medicare and Medicaid Services
1301 Young Street, 8th Floor
Dallas, TX 75202
1-214-767-6301

Oklahoma State Department of Health
Medical Facilities Service
1000 N.E. 10th Street
Oklahoma City, OK 73117
1-405-271-6576

Where can I get more information about my rights under EMTALA?

For more information about your rights under EMTALA, check out:

Detailed FAQs about EMTALA (Link: http://www.emtala.com/faq.htm)

EMTALA Statutes (Link: http://www.access.gpo.gov/uscode/title42/chapter7_subchapterxviii_partd_.html)

EMTALA Regulations (Link: http://www.access.gpo.gov/nara/cfr/waisidx_07/42cfrv4_07.html)

EMTALA Regulatory Guidelines, updated 2008(Link: http://www.cms.hhs.gov/surveycertificationgeninfo/downloads/SCLetter08-15.pdf)

Last Review and Update: Sep 05, 2008
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