# Emergency medical services free of charge?



## Encolpius

From the 1st Jan. people need to pay 3€ if they visit an emergency medical service in the Czech republic. It was completely free of charge before. How about your country? Do you need to pay if you go to the Emergency with a stomach ache or broken leg? If I am not mistaken that service is also completely free of charge in the USA. But how about other countries? It would be also interesting to read how much you need to pay. Thanks a lot.


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## PABLO DE SOTO

Medical emergencies are free of charge in Spain, but there are (few) voices claiming that a fee is needed to avoid the overuse from many people who visit that service without a real emergency reason.


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## TimLA

Interesting question.
In the US, every patient who comes to the ER with a complaint MUST be seen by a physician.
Questions of fees come later.
If you have no insurance, you will probably receive a bill, but most likely it will not be paid, and few hospitals will go after you.
If you have insurance, sometimes you are obliged to pay a "co-pay" for the visit, and sometimes that can be quite high.

In the 80's and 90's, it was found that in a managed care environment, the addition of a co-pay for services such as office and ER visits would decrease utilization of that resource.

Most ER visits are truly NOT emergencies, and thus it seems a reasonable measure.


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## clipper

In the UK emergency treatment in hospitals is provided free of charge in the first instance. However if the injuries are sustained in a road traffic accident a fee is applied (I think it is around 20 pounds). Of course the individual would only end up paying this if their level of insurance was minimal, most of the time the insurance company would pay.


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## Paulfromitaly

TimLA said:


> Interesting question.
> In the US, every patient who comes to the ER with a complaint MUST be seen by a physician.
> Questions of fees come later.
> If you have no insurance, you will probably receive a bill, but most likely it will not be paid, and few hospitals will go after you.
> If you have insurance, sometimes you are obliged to pay a "co-pay" for the visit, and sometimes that can be quite high.
> 
> In the 80's and 90's, it was found that in a managed care environment, the addition of a co-pay for services such as office and ER visits would decrease utilization of that resource.
> 
> Most ER visits are truly NOT emergencies, and thus it seems a reasonable measure.



Does it make any difference whether the patient is an American citizen or a foreigner (a tourist) ?


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## Broccolicious

clipper said:


> In the UK emergency treatment in hospitals is provided free of charge in the first instance. However if the injuries are sustained in a road traffic accident a fee is applied (I think it is around 20 pounds). Of course the individual would only end up paying this if their level of insurance was minimal, most of the time the insurance company would pay.


 
Are you sure about this, Clipper? I've only done a cursory web search, but it seems that the individual could only be charged by a doctor if the treatment wasn't received in a hospital (for example, if the doctor happened to be passing when the accident happened). The National Health Service might claim money from the individual's insurance company, yes, but isn't the whole principle of the NHS that all treatment is free at the point of use?

(I'm going to have to start looking both ways before I cross the road if I'm likely to be charged for hospital treatment!)


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## clipper

Broccolicious said:


> Are you sure about this, Clipper? I've only done a cursory web search, but it seems that the individual could only be charged by a doctor if the treatment wasn't received in a hospital (for example, if the doctor happened to be passing when the accident happened). The National Health Service might claim money from the individual's insurance company, yes, but isn't the whole principle of the NHS that all treatment is free at the point of use?
> 
> (I'm going to have to start looking both ways before I cross the road if I'm likely to be charged for hospital treatment!)


 
On investigation it appears that you are correct Broccolicios, as of 1999 this system was revised, doing away with the charge of 21 - 30 pounds which was previously payable directly by the injured party and replacing it with a mechanism whereby the health authority was empowered to recover a higher amount direct from insurers.

Sorry for the outdated information in my first post. It came from my personal experience as in the past I have received a bill for emergency treatment after an accident, obviously this was prior to 1999.


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## TimLA

Paulfromitaly said:


> Does it make any difference whether the patient is an American citizen or a foreigner (a tourist) ?


 
Nope, *any* "person" who comes to an ER window must be seen by a doc.
HERE's the wiki.

Now this only applies to hospitals that receive funding from the federal government - Medicare.

I'm not sure there is any hospital in the US that doesn't.

They would lose all their Medicare payments if they have been found to violate this law...it would be a huge hit to the bottom line.

NB: I've seen dogs, cats and even a parrot treated in an ER, but they don't count according to federal guidelines!


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## Etcetera

In Russia, emergency medical services are free for people with policies of obligatory medical insurance (every citizen of Russia receives one for free). But paid ambulances also exist, and you can often hear recommendations to call paid ambulance if you have money to pay for it - because with paid ambulance you won't hear that your case isn't worth troubling the doctors, you won't have to wait for hours, you won't hear rude words from the doctors, etc, etc. 

It doesn't mean that free of charge ambulance works that badly. It just depends on the brigade.


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## sokol

In Austria medical insurance is obligatory, and even if you are out of work or on predicament pay (or even if you don't receive predicament pay) you nevertheless will be insured - as long as you are registered.

For those insured medical treatment is free, be it an emergency or not, with minor fees attached (e. g. you will have to pay a recipe tax per drug you get prescribed which would be about € 3 or 4 per recipe; you also will have to pay a rather symbolic amount each day you stay in hospital for food - I don't know exatly how much, I think in the region of € 5 per day).

Foreigners without medical insurance will be treated free of charge, with the same small fees Austrians have to pay, if there is an agreement with their home country medical care system (this is the case for EU members and some other countries).
If this is not the case I am not sure what would happen: you certainly will get treatment without any questions about payment asked in a case of emergency. But I don't know what will be done if later it becomes clear that the patient is not insured and unable to pay for the treatment.


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## jinti

When you go into an Emergency Room (ER) in the US, you will be asked whether you have health insurance (if your condition allows questions like that before treatment ).  

If you don't and it's a private hospital, an emergency will still be treated, but non-emergencies (or stabilized emergencies) can be sent off to a public hospital so that the private one doesn't get stuck with your bill.
If you don't and it's a public hospital, you'll be treated but you'll either have to pay the whole bill, which can be astronomical, or a portion of it on a sliding scale, or become a Medicaid patient (Medicaid is a government program for some low-income people).
When I went to the ER some years ago with possible appendicitis and no insurance, I was considered a Medicaid patient even though I didn't actually have Medicaid. It's just that in that neighborhood, hardly anybody has either insurance or money, so when the staff heard I had no insurance, they just shrugged and wrote Medicaid... (38% of the patients at this particular hospital are "indigent with no insurance", 50% have Medicaid or Medicare, and only 12% have other insurance. _source_ That's partially the result of private hospitals ditching their indigent and Medicaid patients onto this hospital.) 

Judging from the neighborhood and what I saw during my time in the ER, the vast majority of the patients weren't from the US. I doubt they were all documented immigrants either. It didn't seem to make any difference. 

There's an article about "medical immigrants" at that same hospital here. I can't imagine that they're a large percentage of patients, but it has raised some ethical issues.


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## Chaska Ñawi

In Canada a proportion of our provincial income tax (as opposed to our federal income tax) is dedicated to health care.  We all have provincial health cards with our names and a reference number, which we show whenever we seek medical treatment.

Most medical treatment (not cosmetic surgery, for example) is free upon presentation of that health card, in whichever province we happen to be.  Without that health card, we still get treated ... and subsequently billed.


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## alexacohen

In Spain emergency services are free. It doesn´t matter if you are Spanish, British, Mexican or whatever. If you have insurance or not. If you are staying in our country legally or not.

It doesn´t matter for how long you will have to stay at the hospital afterwards. No one will ask you to pay the bill.

Of course the health care service is not free at all; it is paid beforehand because, after all, we pay for it with when we pay our income tax.


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## Lorena1970

TimLA said:


> Nope, *any* "person" who comes to an ER window must be seen by a doc.
> HERE's the wiki.
> 
> Now this only applies to hospitals that receive funding from the federal government - Medicare.
> 
> I'm not sure there is any hospital in the US that doesn't.
> 
> They would lose all their Medicare payments if they have been found to violate this law...it would be a huge hit to the bottom line.
> 
> NB: I've seen dogs, cats and even a parrot treated in an ER, but they don't count according to federal guidelines!



I am a bit surprised about that...When I was in USA as a tourist, in New York state to be precise, it happened to me to suffer of a kidney colic, something that you all know happens suddenly and it is very painful and impossible to be treated at home.
I didn't have an insurance, but I had a credit card.
As soon as I reached the ER at the hospital (not in New York but in a Westchester small town) showing them my green face and asking for help, the first thing I was asked for was "how much do you want us to take off your credit card?"
Of course I was in very bad conditions, not able to quantify how much to give them being overwhelmed by such a terrible pain, and being at same time astonished to be asked for that BEFORE they calmed my pain.

Reading this discussion, if I am not wrong, I understand that they should have treated me before asking for money.
Am I worng?

Thank you.


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## Encolpius

Lorena1970 said:


> ...the first thing I was asked for was "how much do you want us to take off your credit card?


 
You should have said you hadn't had any credit card. I think they must have treated you free.


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## TimLA

Lorena1970 said:


> I am a bit surprised about that...When I was in USA as a tourist, in New York state to be precise, it happened to me to suffer of a kidney colic, something that you all know happens suddenly and it is very painful and impossible to be treated at home.
> I didn't have an insurance, but I had a credit card.
> As soon as I reached the ER at the hospital (not in New York but in a Westchester small town) showing them my green face and asking for help, the first thing I was asked for was "how much do you want us to take off your credit card?"
> Of course I was in very bad conditions, not able to quantify how much to give them being overwhelmed by such a terrible pain, and being at same time astonished to be asked for that BEFORE they calmed my pain.
> 
> Reading this discussion, if I am not wrong, I understand that they should have treated me before asking for money.
> Am I worng?
> 
> Thank you.


 
They can do that, but you don't have to give them anything.
If they don't provide you treatment, they're breaking the law.
The best way to handle that would be to say:
"I have no insurance, I have no money, I'm in terrible pain, please help me."
They don't help you, they are are toast!

This law doesn't generally apply to private offices or walk-in clinics (urgent care).


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## Lorena1970

Thank you Tim.

I wonder WHY they try anyway to ask for money in advance.

I mean, if rules are that they should help people anyway in advance as soon as they join the ER in TRULY bad conditions (and no doubts my conditions were: it was evident to the doctor as soon as I get in!), why they ask for money anyway?

This sounds a bit odd to me as a custom.

This means that they cannot avoid to treat you but at same time they can try to make you pay in advance whatever amount of money? If I feel bad and not completely conscious (as I was due to the gravity of my desease), I can give them whatever amount, maybe more than the proper fee for treatments..........
This make me think, and I am probably wrong, that the final bill can be completely different if I say I am out of money and do not even show them a credit card nor give them a proper address to which send the bill...
So, all the thing can turn to be free or cost a lot depending on the way we "play" our role of hill people...?

I just remember I paid a lot....

Thank you.


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## TimLA

Lorena1970 said:


> Thank you Tim.
> I wonder WHY they try anyway to ask for money in advance.
> I mean, if rules are that they should help people anyway in advance as soon as they join the ER in TRULY bad conditions (and no doubts my conditions were: it was evident to the doctor as soon as I get in!), why they ask for money anyway?
> This sounds a bit odd to me as a custom.
> This means that they cannot avoid to treat you but at same time they can try to make you pay in advance whatever amount of money? If I feel bad and not completely conscious (as I was due to the gravity of my desease), I can give them whatever amount, maybe more than the proper fee for treatments..........
> This make me think, and I am probably wrong, that the final bill can be completely different if I say I am out of money and do not even show them a credit card nor give them a proper address to which send the bill...
> So, all the thing can turn to be free or cost a lot depending on the way we "play" our role of hill people...?
> I just remember I paid a lot....
> Thank you.


 
They do that because there are some people who will pay.
There are a variety of other "tricks" hospitals use to increase income.
One, they "bill" three-times the cost, and occasionally, someone who is ultra-rich will pay it.
The other is they will continue sending "bills" to patients after discharge,
knowing that the patients aren't responsible for that part of the bill.
But sometimes, a patient will pay anyway.

And you are right, you have to learn how to "play the game" just like any process.


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## Lorena1970

As far as I am concerned, this is very different from Italy.
Here costs are fixed, in case you have to pay (for instance if you should buy drugs they prescribe after treating your emergency), but generally who goes to the ER doesn't pay nothing and is not even asked to pay (nor to "play"...) 

So, for instance, if you gave them your credit card number and later avoid paying a bill, they can take off money from it anyway to cover the whole amount?

Thank you.


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## TimLA

Lorena1970 said:


> As far as I am concerned, this is very different from Italy.
> Here costs are fixed, in case you have to pay (for instance if you should buy drugs they prescribe after treating your emergency), but generally who goes to the ER doesn't pay nothing and is not even asked to pay (nor to "play"...)
> 
> So, for instance, if you gave them your credit card number and later avoid paying a bill, they can take off money from it anyway to cover the whole amount?
> They might be able to, but you could stop it by filing a dispute with your credit card company.
> Thank you.


 
I took my wife to an ER in Florence one night and was charged.
Wasn't much, but it was clear the doc was upset that we had awakened him.


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## Lorena1970

Thank you.


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## fsabroso

TimLA said:


> Interesting question.
> In the US, every patient who comes to the ER with a complaint MUST be seen by a physician.
> Questions of fees come later.
> 
> In the 80's and 90's, it was found that in a managed care environment, the addition of a co-pay for services such as office and ER visits would decrease utilization of that resource.
> 
> Most ER visits are truly NOT emergencies , and thus it seems a reasonable measure.


That's true.

Most of the patients, who won't pay (because Medicare or they don't care the bill) go to ER for whatevere reason.  

They don't show any signs of injury or medical problem, they just say _"I have this problem for sometime and I'm wondering what it could be"_



Paulfromitaly said:


> Does it make any difference whether the patient is an American citizen or a foreigner (a tourist) ?


No, They are the same, even illegals who are been caught by border patroll agents have the same treatment and care. We provide the best care no matter residence status. If they, I mean all patients, need specialized treatment they are transfered to another facilities, even by plane or helicopter.



TimLA said:


> Nope, *any* "person" who comes to an ER window must be seen by a doc.
> HERE's the wiki.
> 
> Now this only applies to hospitals that receive funding from the federal government - Medicare.
> 
> I'm not sure there is any hospital in the US that doesn't.
> 
> They would lose all their Medicare payments if they have been found to violate this law...it would be a huge hit to the bottom line.
> 
> NB: I've seen dogs, cats and even a parrot treated in an ER, but they don't count according to federal guidelines!


I don't know the rest of USA; but at least in Texas, there are Emergency departments who have a "fast-track" area, where the minor problems (twisted ankle, feverish patients, etc) are seen by Physician Assistants "under" the supervision of ER Physcician, in order to decreased the waiting times.



Etcetera said:


> In Russia, emergency medical services are free for people with policies of obligatory medical insurance (every citizen of Russia receives one for free). But paid ambulances also exist, and you can often hear recommendations to call paid ambulance if you have money to pay for it - because with paid ambulance you won't hear that your case isn't worth troubling the doctors, you won't have to wait for hours, you won't hear rude words from the doctors, etc, etc.
> 
> It doesn't mean that free of charge ambulance works that badly. It just depends on the brigade.


In Texas not always the ambulance services are part of the hospital services. 

The ambulance services in the city I live are of the city or private, and they send their bills to the patients.

Also, the medical air services are provided and billed separately.


In Peru, there are three ways:

Work insurance, an amount from your pay check is taken, so, you don't need to pay for medical services.
Public hospitals, they will charge you, if you don't earn much, or you don't work, you (o relative) should talk to Social Services, they could decrease the amount or, even, cancel it.

Private, it will depend of your contract.


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## shoam

In Argentina, the public hospitals are totally free for anyone.
Once, when I was a tour guide, in Bariloche (in Patagonia) I was the private English speaking tour guide and escort for a couple. We were back in town from a tour and the man fell in the street and had a bad pain in his knee. He was in his late 70 or 80s, so I took him to the public hospital. He was lucky, there was nobody and he barely had a wait. The doctor spoke some English and everyone was very friendly and was in the good mood. The visit was very short and the man was ready to pay. I was his referent; he did not speak any Spanish. He asked me:
-Where do I pay?
-It’s a public hospital, you don’t have to pay
He could not believe it. He said that he wanted to pay because it was clear the hospital needs money and, his insurance was going to pay anyway, it was not his money. He said many times that he was not Argentinean so did not pay any taxes. It does not matter; health is for everyone in this country. 
It took a long time, many explanations; he insisted in paying somehow and doctors and nurses were very surprised that the situation was so strange to him. They kept asking, "you don't have public hospitals in the US?”. He was surprise too. Finally, someone called a person form the “cooperadora”, a sort of association that helps fundraising. She accepted a donation.
It was a very educational experience for everyone.


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## Sepia

TimLA said:


> Nope, *any* "person" who comes to an ER window must be seen by a doc.
> HERE's the wiki.
> 
> Now this only applies to hospitals that receive funding from the federal government - Medicare.
> 
> I'm not sure there is any hospital in the US that doesn't.
> 
> They would lose all their Medicare payments if they have been found to violate this law...it would be a huge hit to the bottom line.
> 
> NB: I've seen dogs, cats and even a parrot treated in an ER, but they don't count according to federal guidelines!


 


That the patient must be seen by a physician does not tell us much ... does the doc have to do more than what is necessary to keep the patient alive, bluntly speaking? I mean like stopping bleeding, stabilizing the patient, preliminary casting of broken bones. Which does not mean that any setting of fractures or any other treatment is included.

I was working with an international travel medical insurance service (years ago) and never saw US hospitals really doing anything than the abovementioned as long as they did not have a coverage guarantee by fax or telex from us. What they always did was charge 500 $ from the credit card of the patient (if he had one) to cover the basic charges for the first day in hospital.


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## TimLA

Sepia said:


> That the patient must be seen by a physician does not tell us much ... does the doc have to do more than what is necessary to keep the patient alive, bluntly speaking? I mean like stopping bleeding, stabilizing the patient, preliminary casting of broken bones. Which does not mean that any setting of fractures or any other treatment is included.
> 
> I was working with an international travel medical insurance service (years ago) and never saw US hospitals really doing anything than the abovementioned as long as they did not have a coverage guarantee by fax or telex from us. What they always did was charge 500 $ from the credit card of the patient (if he had one) to cover the basic charges for the first day in hospital.


 
They must do what is medically indicated, and usual for the ER.
A broken bone (arm, foot, should) should be stabilized, and then the patient should be sent to an orthopedist as an outpatient.
Any patient needing admission, should be admitted.


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## jinti

Sepia said:


> That the patient must be seen by a physician does not tell us much ... does the doc have to do more than what is necessary to keep the patient alive, bluntly speaking? I mean like stopping bleeding, stabilizing the patient, preliminary casting of broken bones. Which does not mean that any setting of fractures or any other treatment is included.


 A *private* hospital in the US only has to stabilize the patient, who can then be transferred elsewhere if he/she cannot pay.  A *public* hospital has to stabilize _and_ provide whatever further treatment is necessary to patients, and cannot turn them away based on ability to pay.


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## Lusitania

In Portugal we usually pay a fee of €7. However, it's free of charges for people with cronic diseases, pregnant women and victims of domestic violence. If the person cannot pay they don't. 
In cases of violence, gennerally the account is sent to the offender.
I had a surgery that would cost me €5000 and I paid €10.

There's no need to have an insurance. However, I have a medical insurance valid for all the Iberian Peninsula (and other countries if asked) and I pay exactly the same in private Hospitals ER as in the Public sector, although ER services are different. Private Hospitals are not prepared for serious cases of emergencies.

It used to be free but many people used it for non emergency cases.


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## MarcB

I would like to address this issue from the US standpoint. First of all the US is a very big country and there are federal(national) laws and state(local) laws and there are loopholes. Er is not free in the US.and the hospital public or private will attempt to collect fees before treatment in most cases.It is true that hospitals can not legally refuse treatment if the patient is unable to pay.
Co-pays exist for insured patients, some are waived if the patient stays overnight, to discourage ER visits for non-emergency cases. Some hospitals feel it is their mission to save people and they treat patients under any circumstances and give the best care.Others overcharge rich and or insured people to make up for indigents.Hospitals will continue to charge patients who do not pay , they refer them to collection agencies including affecting their credit report, so important in the US. They will usually just writeoff illegals.As has been already mentioned some hospitals will refer patients to other hospitals to avoid non-payment and not disobey the law. There is also what is called triage where the hospital has to determine which cases are more life threatening than others.They can refuse care to what they determine are less life threatening than others,sometimes ability to pay may have some influence(unofficially). This is true for overcrowded hospitals. Due to triage several people have died waiting for treatment in Er's and coincidentally some were unable to pay.This is one of the big debates here in America. Most people would like an overhaul of the total health care system others complain they would have to pay more taxes. Often Scandinavian countries are compared to the US, they have universal health care and are among the best in Europe,but look at how much taxes they pay .Most insurance companies have maximum payments due to the plan one's company pays for. Some treatments are unproven or unaccepted for payment and thus ignored. The Er experience varies greatly in the US from very good to very bad. Overcrowded hospitals in poor areas are usually the worst.
My final comment is that the US is among the best health care providers if you have money and among the worst if not. Canadian and European leaders from countries with socialized medicine come to the US for specialized treatment, much to the chagrin of their regular citizens since local treatment is good enough for them. But in the US uninsured and underinsured are sometimes better off somewhere else.


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## Miguelillo 87

Well here in Mexico is free, if you have medical insurance as IMSS, ISSTE Or somethi8ng like that (is providen for the governamente9 it's totally free; in order to have those the only thing you have to do it's to work, the enterprise pay for it and you pay a littel bit too; but oyu can go to ER or to a normal check out and there won't be any payment. 

Also we have the ERUM that's is a special emergency service pay for the governamentwe and also the Red cross, they always help without ask. 

You only pay as etcera said if oyu want a private medical service, by the way not all are very good, only those which are part of prestogious hospitals.


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## federicoft

alexacohen said:


> In Spain emergency services are free. It doesn´t matter if you are Spanish, British, Mexican or whatever. If you have insurance or not. If you are staying in our country legally or not.
> 
> It doesn´t matter for how long you will have to stay at the hospital afterwards. No one will ask you to pay the bill.



Same here in Italy. Emergency services are completely free of charge, regardless of who is requesting for them.

The only exception is if you get treatment without a real emergency reason, i.e. you can be treated free of charge in non-emergency facilities but you refuse to wait. In this case, you have to pay 25€.


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## Sepia

jinti said:


> A *private* hospital in the US only has to stabilize the patient, who can then be transferred elsewhere if he/she cannot pay. A *public* hospital has to stabilize _and_ provide whatever further treatment is necessary to patients, and cannot turn them away based on ability to pay.


 

How do I recognize a public hospiatal when I need one. Do they have some common logo on the door sign or does one simply have to ask.

Not that I think I would ask much in an emergency, but sometimes you drive by and think "ok, this would be the place, if I should need it".


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## JamesM

Sepia said:


> How do I recognize a public hospiatal when I need one. Do they have some common logo on the door sign or does one simply have to ask.
> 
> Not that I think I would ask much in an emergency, but sometimes you drive by and think "ok, this would be the place, if I should need it".


 
That's a very good question!

Not to be facetious, but if it has a saint in the name it is almost surely a private hospital. If it has a religious organization's name (Adventist or Presbyterian, for example) it is almost surely a private hospital. Beyond that I think it gets a little trickier. In my area, for example, the main hospital is "Los Robles". I'm fairly sure it's a private hospital. Kaiser is a large private health network that has several hospitals in the Los Angeles area.

It might be easier to look for public hospitals. If it has "County" in the name, for example, I would assume it was public. 

(I am not in any way defending our health system, by the way. I think it's absolutely screwy. I'm simply trying to answer the question.)

The transfer would be handled automatically by the hospital. You would not have to be involved in it or "pick the right hospital" up front. As a practical matter, the best bet would be to go to the nearest hospital and let the procedure take care of itself.  As far as I know, they would not move you if the move itself would endanger you in any way.


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## KHALIFAH

The payment of a fee for the use of emergency services is currently in force in Colombia. The reason is just to foster a better use of them by the population. It applies as much to private insurance plans as to the mandatory plan (social security). In this case, the amount depends on the personal monthly income and can be between a minimum of USD$1,oo ($1.800 Colombian pesos) and a maximum of $USD9,50 ($18.000 Colombian pesos).


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## jinti

Sepia said:


> How do I recognize a public hospiatal when I need one. Do they have some common logo on the door sign or does one simply have to ask.
> 
> Not that I think I would ask much in an emergency, but sometimes you drive by and think "ok, this would be the place, if I should need it".


 I think JamesM gave a good answer: names with _County_ in them are generally public, and names with _Saint _or a religion in them are pretty reliably private.  I'd just add names with _University_ in them to the private list.

But not all have those words in their names, and you do sometimes just have to ask or read their literature/website/whatever.  Of course, if it's a true emergency, it doesn't matter -- you just go wherever is closest.


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## Miguelillo 87

jinti said:


> . Of course, if it's a true emergency, it doesn't matter -- you just go wherever is closest.


 
MMMH; Now I have another doubt, for example in some tv shows about hospitals (as ER, Grey,, etc) I've notice taht sometime if there's a big accident, as the explosion of a building, or the collpase of the subway a relly bad tragedy; or a multiple crash; Where does people are taken? 

To the closest and emptier hospital? 

Besides People pay for that? I mean it is a very big accident. How the ambulances decided who to take where?


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## JamesM

The routing of ambulances is handled by someone at the scene.  I know that in Los Angeles there is often one person who is dedicated to this task at any accident scene.  They call ahead to determine capacity and route the ambulances to the closest hospital that has the ability to receive the injured.

As far as I know, in the event of a major accident (such as a plane crash, building collapse, explosion, or major fire, for example) all the hospitals in the area are put on alert that there will be an unspecified number of casualties showing up soon at their facilities.


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## Sepia

JamesM said:


> That's a very good question!
> 
> ...
> The transfer would be handled automatically by the hospital. You would not have to be involved in it or "pick the right hospital" up front. As a practical matter, the best bet would be to go to the nearest hospital and let the procedure take care of itself. As far as I know, they would not move you if the move itself would endanger you in any way...


 

That is a good piece of info. Because according to what I hear from Germans who had some kind of accident in Spain, the (usually private) ambulance services usually brought them to either the next hospital - period - or to some hospital that is the cooperational partner of the ambulance service. I suppose they ask first - like "Vamonos a Hospital xx, OK? - and the patient who usually does not understand much Spanish moans "Yeees ... hospital" and thus you have a valid contract. If the patient happens to have private travel insurance this is totally OK, but if he is only covered under the mutual sickness-insurance within the EU (formerly documented with the form E111) he'll have to pay at least the pricedifference as compared to a public hospital or policlinic. 

This is probably an aspect you, as an American, did not think of. You don't travel far in Europe without crossing borders - there are countries so small that I ride across them in one day on my bicycle (like Luxemburg). But the rule is that EU-citizens have the same coverage under the public health care system that the locals have in all states belonging to the EU and I think also the European Economic Area (so this adds Iceland, Norway, Lichtenstein and Swizerland.)




JamesM said:


> The routing of ambulances is handled by someone at the scene. I know that in Los Angeles there is often one person who is dedicated to this task at any accident scene. They call ahead to determine capacity and route the ambulances to the closest hospital that has the ability to receive the injured.
> 
> As far as I know, in the event of a major accident (such as a plane crash, building collapse, explosion, or major fire, for example) all the hospitals in the area are put on alert that there will be an unspecified number of casualties showing up soon at their facilities.


 

In such a case they are of course obliged to do what is necessary to save lives - and what the costs are concerned, they should be covered by the airline or whichever larger organisation is made responsible, anyway.


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## Miguelillo 87

Sepia said:


> In such a case they are of course obliged to do what is necessary to save lives - and what the costs are concerned, they should be covered by the airline or whichever larger organisation is made responsible, anyway.


 
OK I understand that if we are talking about a aircrash or a buscrash, but if the accident was on the subway (at least in Mexico subway id managed for the governament) or fire in  a public building as libraries. 

Does the governament pay? or Who?


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## JamesM

I don't know how it works in other countries, but in the U.S. this kind of matter is resolved in the courts and can take years. In the meantime, as far as I know, there is no obligation to pay the bill.  I don't know that there is a simple answer.


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## Miguelillo 87

JamesM said:


> I don't know how it works in other countries, but in the U.S. this kind of matter is resolved in the courts and can take years. In the meantime, as far as I know, there is no obligation to pay the bill. I don't know that there is a simple answer.


 
OK So for example if I have medical insurance I won't have any problem if they take me wherever. 

But if I don't have I have to go on a trail? 

Besides Public hospital in US How do they work for ER? They attend whoever? 

What is the normal sittuation To have more public or more private hospital in town?


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## TimLA

Miguelillo 87 said:


> OK So for example if I have medical insurance I won't have any problem if they take me wherever.
> But if I don't have I have to go on a trail?
> Besides Public hospital in US How do they work for ER? They attend whoever?
> What is the normal sittuation To have more public or more private hospital in town?


 
Let's break it down a little and use examples.

1. You have a cough and runny nose.
Every ER must "see" you and treat you. You will be sent home. You will be billed for the visit. If you have insurance, the insurance pays (sometimes not all depending on the insurance and how serious your illness was).
If you have no insurance, you will be billed, and most of the time they will get nothing, and you will not be sent "to collections".

2. You have a heart attack.
Every ER must "see" you and treat you. You will be treated just like everyone else (hopefully) and you will be admitted and kept in the primary hospital if they have cath lab facilities. If not, you might be transferred to a hospital that does. If you have insurance, your company will be billed. If you don't, you'll get a bill, and probably won't be able to pay. They will probably not send you to collections.
---------------------------------------
Opinion Warning

1. For major trauma, you probably want to go to a "County" or "Public" hospital, because they are the most experienced in trauma of all types. They often have the most experienced teams and see the most trauma patients. But if you have major trauma, you probably will not have a choice of hospital because (a) you won't be conscious or (b) ambulances are required to take you to the nearest appropriate hospital. These types of hospitals are experienced because many "County" hospitals are in areas that are prone to violence. Sometimes these areas and ER's are called "the knife and gun club" because of the violence.

2. For less than major trauma, you do NOT want to go to a "County" hospital because of overcrowding, understaffing and a variety of other reasons. In fact, you want to stay away from those parts of town because of the "knife and gun club" atmosphere.

3. If you are in the US, and don't have a true emergency and you have insurance, go to a private walk-in clinic.
If not, go to an ER close to you.


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## Sepia

Miguelillo 87 said:


> OK I understand that if we are talking about a aircrash or a buscrash, but if the accident was on the subway (at least in Mexico subway id managed for the governament) or fire in  a public building as libraries.
> 
> Does the governament pay? or Who?



I don't know about the pitfalls in the Mexican judicial system, but I suppose that in most countries the carrier or the owner of the facilities would be the first one to be held liable. I airports at least I always see posters stating the "Passengers Rights" according to some international convention. I never read them in detail and don't know if they are applicable on flight passengers only.

I think it would be a good idea for all of us to read them.


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## shoam

That's how it is here, TimLA, in the State of Washington, King County (Seattle). 
But not every state is the same.
One thing I can add to what TimLA explained. Once you received the care in the ER or, were admited in the hospital, had surgery, etc, and, you cannot pay the bill or your cut of the bill. Then, you (a friend or family member) have to start the paperwork for charity care. You have to provide household income information, bank account info, children under 18, renter or owner?, etc. I am a medical interpreter and for what I have seen, most of "low income" patientes, specially children, get the medical care they need for free.
This is for the County Hospital, University Medical Center or the Children's Hospital only, of course.

* OPINION:* They way it should be, especially in a rich coountry.


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## Cheesee = Madness

Chaska Ñawi said:


> In Canada a *Large* proportion of our provincial income tax (as opposed to our federal income tax) is dedicated to health care.  We all have provincial health cards with our names and a reference number, which we show whenever we seek medical treatment.
> 
> Most medical treatment (not cosmetic surgery, for example) is free upon presentation of that health card, in whichever province we happen to be.  Without that health card, we still get treated ... and subsequently billed.



I've had a recent experience with our health-care system.
On my birthday the pavement and my face had a little disagreement and I got cut up pretty badly. I wasn't conscious afterward, but from what I was told they had to pay for the ambulance ride(It was something close to $100), but everything else was free. I didn't have my health card on me, but they didn't bill me. Also, the people who payed got a refund a couple months later from the government.


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## Miguelillo 87

Chaska Ñawi said:


> In Canada a proportion of our provincial income tax (as opposed to our federal income tax) is dedicated to health care. We all have provincial health cards with our names and a reference number, which we show whenever we seek medical treatment.
> 
> Most medical treatment (not cosmetic surgery, for example) is free upon presentation of that health card, in whichever province we happen to be. Without that health card, we still get treated ... and subsequently billed.


 
Sorry Chaska a question; this healt card is given to population, how? When thet pay taxes is given? You've got this card at what age? from 0 to 99 yrs old? 

And if you are a tourist and you have an accident, they are going to bill you too, I supposed; but there isn't public hospitals in Canada?


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## Chaska Ñawi

We register all our children for health cards at birth, and the cards arrive a few weeks later.  Immigrants receive health cards when they achieve resident status, which basically confers all the privileges of citizenship except the ability to vote.

A certain percentage of our taxes is dedicated to health care, but the hospitals still have lotteries and other fundraising campaigns to buy such items as MNRs.

All our hospitals are public hospitals, although one finds the occasional private clinic.  Mostly these clinics are for cosmetic surgery; but some offer procedures which are offered publicly but with longer wait times, such as hip replacements.  These latter clinics are extremely controversial, because they withdraw staff and resources from the public systems.

If you are a tourist, they will treat you and then bill you or your insurance company.


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## Brioche

Encolpius said:


> From the 1st Jan. people need to pay 3€ if they visit an emergency medical service in the Czech republic. It was completely free of charge before. How about your country? Do you need to pay if you go to the Emergency with a stomach ache or broken leg? If I am not mistaken that service is also completely free of charge in the USA. But how about other countries? It would be also interesting to read how much you need to pay. Thanks a lot.


 
If you are a legal resident of Australia, you are covered by the Australian Medicare system, and treatment in a public hospital is free.

Australia has reciprocal agreements with New Zealand, United Kingdom, Ireland, Norway, Sweden, Netherlands, Finland, Italy and Malta, so if you are a tourist from those contries you will also get _*emergency* treatment_ free at a public hospital emergency service.


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## Lugubert

All Swedes, employed or otherwise taxpayers or not, are covered by the same Universal Health Care system. For minors, everything is perfecly free, including all imaginable necessary cases of dental care.

On emergencies, as well as on any other physician visit*), there is generally a basic fee of some $20, which calculates towards the annually accumulated maximum of $110 for any and all tests and procedures, should they even include multiple MRIs or a heart transplant. Patients who don't present cash or cards on entry will be billed, and if desitute, the amount will be waived.

Prescription drugs, be they unique growth hormones or standard antibiotics or whatever, carry an annual total max of ca. $220.

*) Selected specialists may charge a few dollars more. OTOH, seeing a regd. nurse to have a cast removed or a catheter pulled etc. is some $8.


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## HUMBERT0

In my state we have IMSS that is the Mexican Social Security System every worker in the country is register and the employer and the employee pay an amount for Social Security, If you work for the Federal Government you have ISSSTE it’s a Social Security System for Federal workers (Teachers, Arm Forces, Mexican IRS workers, etc.). If you are employed by the state you’ll have ISSSTECALI for employees of the state of Baja California. And if you have none of the above, you can go or they’ll take you to the General Hospital where you pay what you can. The Red Cross also has Hospitals, but they only do Emergencies and provide First Aide in accidents or medical emergencies, and then the patients get transfer to the General Hospital or IMSS, ISSSTE, etc. (And the Red Cross does charge now…) 
And of course there are your private Hospitals, Clinics, Maternities, etc.). Now in case of a Real emergency (In life or death situations) you can go to the nearest (ER) Emergency Room of the Public Health Sector (IMSS, ISSSTE, etc.)  and get treated… they must help even if is not your hospital… it is the Law.


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