Emergency Medical Condition
What Is An Emergency Medical Condition?
An emergency medical condition is defined as a medical condition that manifests itself through severe symptoms of sufficient severity which include pain and as such if immediate medical attention is not offered to the person it will result; jeopardizing the person’s health, severe impairment of their body functions or a dysfunction of part of their body or organs.
The Federal government Legislative Session in 2004 amended the Personal Injury Statute (PIP) under House Bill 119 which took effect in 2013. The bill aimed to address the range of medical coverage that an individual gets if they get involved in a vehicle accident it outlines the procedures medical staff is to follow in determining whether a case is an emergency medical condition.
Emergency Medical Condition Letter
The permanent status does not state that the doctor is supposed to fill an emergency medical condition letter however to receive the full insurance your medical record has to establish an emergency medical condition was present.
In 1986, the United States Congress established the Emergency Medical Treatment and Labor Act (EMTALA) with the aim of providing citizens with access to emergency services regardless of their ability to fund the services. The Emergency Medical Treatment and Labor Act (EMTALA), which is also called the ‘Patient Anti-Dumping’ statute, was created in order to keep tabs on medical facilities that offer Medicare from exempting patients that need emergency medical care because of the insurance status.
Transferring Emergency Medical Conditions
Under Emergency Medical Treatment and Active Labor Act, the emergency medical condition letter stipulates that if it is determined that EMC exists, the hospital must provide treatment and ensure the patient is stabilized before they are transferred to another facility if a need arises.
This schedule of the act restricts the transfer of unstable individuals, and such transfers should be “appropriate transfer only done solely for medical necessity. The Emergency Medical Treatment and Active Labor Act explains that such a transfer can just be done when the medical benefits for the patient outweigh the risks involved. In case the hospital admits the patient for treatment in their facility then the EMTALA obligation ends and the state tort governs the legal adequacy of the care that is given.
The emergency medical condition letter also states that when a transfer is done under Emergency Medical Treatment and Active Labor Act and the facility that is receiving the patient has the capabilities and facilities to give care to the patient they should not under no circumstance refuse to accept the transfer. Another area of concern under EMTALA is when the statute responsibility begins since the assumption is a patient has to be admitted to a hospital facility first since it states “come to. CMS clarified by saying that the responsibilities of the emergency condition letter begin immediately after the emergency department has been notified of a patient’s arrival, meaning even when the patient is en route the statute is in operation they do not have to be physically present at the facility.
Tied with this is the concern of the amount of uncompensated emergency care given by hospital staff under emergency medical condition letter, cost shifting becomes a challenge especially for patients who are making out-of-pocket payments. Despite the many challenges that are involved in the act the Emergency Medical Treatment and Labor Act has helped patients who in normal circumstances could be segregated, get the medical care and attention they need thus saving lives.
The 14-Day Rule
All car owners in the United States are required by the law to have insurance which in case of an accident, the injured parties receive accident medical coverage without considering who is at fault. The guarantee covers the drivers’ 80% medical bills which are up to $10,000 expense limit. Initially, there was no time limit, within which this cover could be used for injured persons, however, with the amended provision the motorist is supposed to seek medical treatment within 14-days of the accident-failure to which they have forfeited their coverage.
This law is meant to reduce the number of people who are compensated by insurance agencies which in turn increases their profit margin. According to the Federal Government, this change in the emergency medical condition under the PIP is necessary to decrease the level of fraud that was being experienced during compensation of claims. The emergency medical condition statute has left many physicians wondering what constitutes an emergency because according to the definition there is a lot of room for interpretation of the terminology. The emergency medical condition statue which is the amended form took effect on January 1, 2014, and outlines that a finding of an emergency medical condition (EMC) must take place for a person to have aces to the full $ 10,000 compensation and if the physician determines that the injuries do not meet the levels established the claimant gets just $2500 in PIP benefits.