HospitalInspections.org

Based on a review of facility policy, medical records (MR), facility documentation, and interviews with staff (EMP), it was determined that the facility failed to ensure authorization from an individual's insurance company for screening or stabilization services were sought after the hospital provided the appropriate Medical Screening Examination to determine whether or not an Emergency Medical Condition exists.

Findings Include:

Review of facility policy " EMTALA-MEDICAL SCREENING EXAMINATION AND STABILIZATION POLICY ... Reference #: 7034AHN ", last revised 12/2019, revealed: " ... Once the MSE is complete and stabilizing treatment has been initiated, the hospital may request information from the individual's health plan such as medical history of the individual or authorization to provide additional services, so long as doing so does not delay or interfere with the stabilizing treatment. ... " .

A review of MR1 revealed that the patient presented to the hospital's Emergency Department on October 20, 2021, with a chief complaint of toe pain. Further review of MR1 revealed that the patient's insurance was run prior to completion of a Medical Screening Exam by the physician. MR1 left the hospital without being evaluated by the physician.

During an interview on November 2, 2021 at approximately 1:30 PM, EMP1 confirmed that the patient's insurance was run prior to receiving a Medical Screening Exam.