One Dozen Things

Who Pays the Bills?

Overview

The United States does not have universal health coverage, and reimbursement or payment for medical care is extremely complex. The type and amount of a patient’s medical coverage can significantly affect access to care and availability of options for elective medical treatments.

Many people have health insurance through their employer. U.S. citizens aged 65 and older and those who are permanently disabled are typically covered by a nationally funded program called Medicare. Additionally, Medicaid programs are administered by individual states and provide coverage for some poor or disabled people. Military personnel and veterans are typically eligible for medical services within the extensive Veterans Administration system of hospitals and clinics. Unfortunately, there are more than 40 million U.S. citizens who have no medical coverage at all. To provide protection in the event of an acute medical emergency, a comprehensive set of federal laws known as the Emergency Medical Treatment and Active Labor Act (EMTALA) dictates that no patient may be turned away from emergency facilities regardless of his or her ability to pay. Nevertheless, the uninsured poor are medically vulnerable, with limited options for preventive and non-emergent care outside of free clinics and special public facilities.

It is important to be aware of the type of medical coverage your patients have and how it may impact their care. When ordering tests or writing prescriptions, it is a good idea to ask a patient if she or he will be able to pay for the test or medication (even generic drugs can be quite costly). Social workers and administrative staff can assist patients in determining their eligibility to apply for public benefits (such as health insurance) and can aid you in determining optimal treatment within the context of the patient’s care plan and financial resources.

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