Visitor Question

Can Urgent Care refuse medical treatment to my son because of outstanding bill to insurance?

Submitted By: Heather (Bethlehem , Pennsylvania)

I took my son to Urgent Care because he was having trouble breathing with his asthma. As I sat down to get him registered the triage nurse proceeded to tell me that because my daughter (who was not being seen) has a medical bill that the insurance has not responded to yet,  they would not be able to see my son.

Their nurse printed out me a copy of the bill and turned us away! Needless to say, I’m disgusted because anything could have happened to my son because he was having issues with his breathing and he was wheezing.

I took him to another urgent care and he was seen immediately where they prescribed him steroids and nebulizer treatments for his asthma. My question is, is it legal to turn my son away because of a bill when he needed urgent medical care? I appreciate any information you can give me.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Heather ,

Given the circumstances of your case, it was probably legal for urgent care to deny medical treatment.

The federal Emergency Medical Treatment and Labor Act (EMTALA) requires private hospitals to treat people with emergency medical conditions, regardless of the person’s ability to pay. Your son’s difficulty breathing was an emergency. Any private hospital with an ER had a legal duty to treat and care for your child.

A problem here is that you took your child to an urgent care center. EMTALA doesn’t apply to every type of medical facility. The following are not subject to the law:

  • Private doctor’s offices
  • Stand-alone medical labs,
  • Specialty hospitals without emergency rooms, and
  • Most urgent care facilities.

These providers can deny treatment, even if an emergency, for many reasons. These include:

  • The provider not having a working relationship with a person’s health insurance company
  • The person seeking care cannot pay for the costs of treatment
  • The person hasn’t paid for a prior visit
  • The provider has stopped doing business with a patient’s health insurance provider

Updates to the law and federal court decisions have indeed begun to include urgent care centers under EMTALA. For example, when there is no doubt that the facility treats emergencies, or when the urgent care center is run by the local hospital and is approved for Medicare patients.

Medical malpractice cases should always be handled by a skilled attorney. There doesn’t appear to be a  Pennsylvania statute that directly applies to your son’s case. However, a local attorney can tell you if the facility in question is subject to EMTALA, and if there may be remedies under Pennsylvania case law that apply to your situation.

Learn more here: Recourse for Medical Treatment Denial

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.

Find a local attorney to give you a free case review here, or call 888-972-0892.

Best of luck with your claim,

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