One of the satisfactions - perhaps the foremost - of working in an emergency department is the vast majority of people are improved as a result of their visit.
Their pain is controlled, their cuts sewed up, fractures splinted and other conditions, medical and traumatic, are diagnosed and treated in real time.
However, going to an emergency department usually is not elective: Patients are compelled to go there for whatever pain, injury or illness afflicts them.
Beyond the immediate necessity and discomfort lies the anxiety of financial cost - thousands of dollars is not a rarity these days. Even the insured have concerns, if not worries: deductibles, co-pays, coverage issues and possible denials, to name a few.
As emergency physicians, we are required by federal law to care for and to use all of the hospital's resources for anyone entering. It is illegal to request payment information before at least a screening examination. It is something of a blessing that ER doctors, usually paid by the hour, have little knowledge of a patient's resources (we do understand cost realities).
How bad is it? A survey of Florida emergency departments published in 2005 revealed uncompensated or "free" care ranged "from 26 to 79 percent with an average of nearly 47 percent." Is it any wonder that about 10 percent of California hospitals have closed their emergency departments in the last decade?
The reasons for uncompensated care are simple: Patients are poor, they walk on the bill and "denial of payment for emergency services by health plans."
"Denial" seems a bit contradictory, given the accepted definition of an emergency as occurring whenever an individual perceives there is an emergency.
When I opened my mail a few years ago, I was surprised to discover I was included in a lawsuit. But it was a class-action suit, not the malpractice variety. It began in 1999 in Alabama with a doctor who alleged that several HMOs and insurers had "used fraudulent marketing tactics," "financial incentives to restrict patient care" and breached "their obligations under federal law to provide necessary medical care." Other lawsuits by medical societies, medical associations and physicians soon accumulated in the next several years until consolidated under the federal Racketeer Influenced and Corrupt Organization Act.
Settlements by for-profit health plans came after, namely Aetna, CIGNA, Health Net, Prudential, WellPoint/Anthem and Humana. The settlement for physicians, including ER doctors, was $400 million. I returned the mailing to a folder only to re-examine it a few weeks after the deadline for filing a claim.
As an ER doctor who has worked three decades of nights, weekends and holidays, I have become increasingly angry at what was systematic down-coding, delaying and denial of payment by these "for-profits."
What is even further over the top is if they have stiffed me and my colleagues, they also have screwed their very subscribers. That is far worse. Just perhaps, there is some room for health-care reform?
Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.