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Old 03-30-2011, 12:52 AM   #1
Juno Styles
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Default Will the hospital kick you out if you can't pay?

I have a character who's mother was rushed to the hospital for complications revolving around her having cancer. She needs surgery to have it removed while it's still early. They are way behind on their past medical bills and recently lost their medical insurance.

How would the hospital typically handle this situation? Throw them out on their as$? Refuse to do surgery unless they can pay? Or work with them somehow?
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Old 03-30-2011, 02:05 AM   #2
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Default Re: Will the hospital kick you out if you can't pay?

Quote:
I have a character whose mother was rushed to the hospital for complications revolving around her having cancer. She needs surgery to have it removed while it's still early. They are way behind on their past medical bills and recently lost their medical insurance.
Welcome to the American Dream.

Your medical knowledge is lacking, but your question is a legitimate one. The medical problem in your question is the presence of "complications" in someone who urgently needs surgery but still only has "early" cancer. That does not describe a true medical situation, but I understand the greater reach of your question.

If the situation is really an emergency, the patient will not be kicked out. She will even undergo surgery if the situation is urgent. However, if matters are not so grim (not an emergency), she may be discharged home from the ER, or may stay a night for further testing (though most was probably done in the ER) and observation.

In larger hospitals, the surgeon who was on call on the day when she came in will maybe assume care for her. However, the situation becomes murky at this point. A lot depends on the disposition of the doctor or surgeon who acquires a non-insured patient in this manner. How willing is he/she to provide free care?

And then we come to the issue of the hospital. Although a hospital has to admit anyone with an emergency who comes through the ER, the whole issue becomes cloudy when the admission is directly from a doctor's office for something not deemed to be an emergency. Typically, the hospital will let the patient in but will start harassing the patient immediately about money.

And do not think for a moment that an average citizen without insurance will ever be able to pay a bill for something like a major surgery for cancer, after extensive tests, the surgeon's fee, the OR time, the anesthesia, and the post-op stay. It will be many, many thousands of dollars.

Welcome to the American Dream.

(EDIT to add: Juno, if you do not know, I am a physician.)
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Old 03-30-2011, 02:54 AM   #3
cshel
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Post Re: Will the hospital kick you out if you can't pay?

In the L.A. area you can go to county hospitals like USC Medical Center and Olive View Medical Center and they will treat people without insurance, who can't afford to pay. If you are rushed to the closest private hospital in an emergency, I think they must try to save you, even if that entails emergency surgery, but if they can stabilize you, they will send you elsewhere, and bill you for what they did. Any doctor or medical facility would have referred as soon as the insurance and money ran out.

I'm not sure what complications would have her rushed to the hospital, if the cancer was discovered early. But aside from just the surgery, the cost of the following chemotherapy, radiation, medication, tests, scans, doctors fees, etc. is staggering as well.
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Old 03-30-2011, 06:47 AM   #4
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Default Re: Will the hospital kick you out if you can't pay?

Is being kicked out of the hospital (or not) important to the story? Just have them do the surgery, elicit the empathy, if that's what you're looking to do, and then move on with your story.

I'm a computer programmer by day and often let "logic" get in the way of a good story. It's a constant struggle between "showing all the facts" and hitting 125 pages, or glossing things over and keeping it at 120.

If my character takes a taxi ride, do I really have to show them paying the driver, so that the viewer doesn't get all hot under the collar thinking "Hey! What taxi driver would give a free ride?!"

I mean, you're not asking that a person suddenly be able to flap their arms and fly -- in the middle of a non-fiction story.

Anyway, there are plenty of places in the world where "getting a free surgery" wouldn't be noticed.
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Old 03-30-2011, 08:51 AM   #5
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Default Re: Will the hospital kick you out if you can't pay?

Kick you out!?

a) First you have to roll around to find hospitals that have NOT CLOSED their ER's due to their not having the state funds to subsidize the care of patients showing up on their doorstep.
b) Having found the "open ER," you may then still be turned away if you cannot pay up front. http://www.chron.com/disp/story.mpl/...l/7475604.html (<<< just one case of many!)

(...and he has a Masters in Health Informatics.)
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Old 03-30-2011, 09:09 AM   #6
Juno Styles
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Default Re: Will the hospital kick you out if you can't pay?

Thanks guys for the replies and input.

@catcon - I get what you're saying, but I need to at least understand the process before I go making stuff up. I need to have this scenario play out in my head so I can deliver it the right way through proper subtext/dialogue and however else I decide to write the scene. Nothing worse than having some regular person say "damn this reads like you just made it up! a hospital would never do that!"

Quote:
Originally Posted by ComicBent View Post
(EDIT to add: Juno, if you do not know, I am a physician.)
Hi ComicBent, I do remember you mentioning that a long time ago now that you have pointed that out.

Maybe emergency was not the right choice of words. I'm trying to create a situation where the boy has to take his mother to the hospital and they find out that she has cancer and they need to have a surgery early before it gets worse. The problem comes in when their insurance has recently dropped them and they're behind on their bills.

Are you able to recommend any type of illness or tests that could have been run that would allow the doctor to discover this?

Also, how long or how big of a window would they typically have in order to get their finances in order before it's considered "too late" and the "early period" is over making it an even more critical situation?
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Old 03-30-2011, 09:19 AM   #7
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Default Re: Will the hospital kick you out if you can't pay?

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Originally Posted by Juno Styles View Post
Maybe emergency was not the right choice of words. I'm trying to create a situation where the boy has to take his mother to the hospital and they find out that she has cancer and they need to have a surgery early before it gets worse. The problem comes in when their insurance has recently dropped them and they're behind on their bills.
I'm not a doctor, nor am I even smart enough to fake it, so others more knowledgeable/professional can chime in, but you may want to have the mom develop a cough or a perhaps she's got a history of pneumonia so they have her checked out. They see on the x-ray, she may have lung cancer. It's also possible that the mom may not be strong enough for surgery so they may admit her to see if she can get stronger with treatments/diet/drugs.

I don't think they can discharge her if she's in ICU, but comicbent or others can confirm/deny.

HH
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Old 03-30-2011, 09:22 AM   #8
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Default Re: Will the hospital kick you out if you can't pay?

"Are you able to recommend any type of illness or tests that could have been run that would allow the doctor to discover this?"

There are SO MANY illnesses that garner a test that we'd be out to several hundred pages answering this. Can you come up with one you want to go with?

For example, the mother is extremely short of breath. The GP recommends her to an oncologist who takes X-Rays and finds untreated breast cancer that has moved from the lymph nodes into the lungs as evidenced by spots. She would then have a mastectomy, or refusing that, radiological treatment...which both get into the expense.

Here's the technical scenario: http://www.breastcancer.org/symptoms...is/staging.jsp
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Old 03-30-2011, 09:25 AM   #9
Juno Styles
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Default Re: Will the hospital kick you out if you can't pay?

Good info I like the shortness of breath and/or nasty cough. Sounds common enough.
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Old 03-30-2011, 10:32 AM   #10
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Default Re: Will the hospital kick you out if you can't pay?

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For example, the mother is extremely short of breath. The GP recommends her to an oncologist who takes X-Rays and finds untreated breast cancer that has moved from the lymph nodes into the lungs as evidenced by spots.
It works the other way around. Breast cancer moves from breast to lymph nodes. Also, the problem in this scenario is that the patient has no insurance. When a doctor's office calls to make a referral, the specialist's office will ask about insurance and will require a substantial deposit up front if the patient has no insurance. And also you would never refer a patient to an oncologist just because the patient was short of breath. Instead, the primary-care doctor would get chest X-rays as a start. But here we come back to the issue of payment, which may be required up front.

Welcome to the American Dream.

Quote:
Having found the "open ER," you may then still be turned away if you cannot pay up front.
Only if your condition is not deemed to be a true emergency. The vast majority of people in an ER do not have a real emergency. They are there for vomiting, dizziness, sore throats, flu-like illnesses, and a zillion other reasons that are not emergencies. Hospitals ask for your insurance information as part of the ER registration process and may ask for money as a partial payment if you have no insurance. Asking for money and demanding it before admission are not the same thing.

Juno, it is hard to answer your question. It is all too complicated to explain in a short paragraph. The problem is that cancers within the body do not cause symptoms until they are advanced. An incidental finding is possible on a CT scan, but why is the CT being done? You could use a complaint of abdominal pain and blood in stool. The patient goes to the ER and undergoes CT scan, which shows a possible mass in the colon. The problem here is that the pain (if caused by cancer) is not an early symptom. So what was the reason for the pain? You see the problem? Everything leads to another question.

Have you thought about trying your hand at a thriller? Comedy?
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