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What Should you do if a Patient is Uninsured?

uninsured patients

If your patient is uninsured, they’re not likely to be able to cover the cost of treatment. However, that doesn’t mean that you can or should always avoid treating uninsured patients. It’s important to consider the circumstances. Here’s what you need to know:

1. You cannot refuse to treat an uninsured patient who is seeking treatment for a medical emergency

Public hospitals are required to provide medical care to patients regardless of their ability to pay. While doctors at a public hospital cannot deny treatment for someone suffering a medical emergency, you are not obligated to treat chronic health problems if the patient is uninsured.

However, the definition of an emergency is not always as clear-cut as you might expect. If the patient is suffering from rapid deterioration and treatment is needed to stabilize them, it is an emergency situation. If you are working at a public hospital, you cannot legally refuse to provide care in these situations even if the patient is unable to pay.

2. Private practices are generally exempt from this guideline

As the owner of a private medical practice, you are not obligated to provide emergency medical treatment. Hospitals feature equipment that is essential for the care of critically ill patients, and it is always best to refer uninsured (or insured) patients to the local emergency room if they are experiencing a medical emergency.

3. Consider offering a sliding scale

If your practice serves a large number of uninsured patients, you should offer a sliding scale. A sliding scale will allow you to charge lower rates if a patient doesn’t have insurance, and many physicians who offer a sliding scale use their patient’s income to determine the rate that they charge. This type of payment system is used by numerous primary care doctors throughout the country, and it can allow you to effectively serve populations with a large number of people who lack health insurance.

4. Always confirm that an uninsured patient truly lacks access to health insurance

While uninsured patients have no access to health insurance at all, under-insured patients do have access to coverage, but the coverage isn’t enough to adequately cover their medical expenses. Due to the fact that uninsured patients don’t have any coverage at all, these individuals are likely to be unable to make any payments.

5. Be very specific when you’re describing the cost of your services

Insured patients will not be paying significant amounts of money out of pocket. Therefore, the specific cost of your services won’t be that important to them, but it’s a very different story for uninsured patients. Uninsured patients will be paying the entire total out of pocket, which means that you need to make sure they know exactly how much your services cost.

If you don’t clearly describe the cost of your services, uninsured patients are likely to seek treatment elsewhere. Furthermore, if they do choose to receive care from you, you may find that they are unable to pay the amount that you charge.

Not only that, but the patient may be surprised by the cost of their care. If this is the case, it could deter others from seeking services from you. So, being upfront about the entire cost of the care of uninsured patients is essential for your practice.

6. Always direct patients to agencies that offer health coverage if possible

In many cases, an uninsured patient will have access to Medicaid or state health insurance programs. However, it is not uncommon for individuals in this situation to be unaware of their options. Medicaid requirements vary significantly from one state to another.

However, NC Medicaid offers health insurance to low-income Americans, and it’s essential to familiarize yourself with Medicaid eligibility in your state if you live outside of North Carolina. Furthermore, some states have their own health insurance program, which provides coverage to individuals who have a low income and don’t receive health benefits from their employer. If there is a state health insurance program in your area, make sure that you are familiar with its requirements.


For more on Medical Billing & Coding, Healthcare Administration, and Insurance News and Updates, you’re already at the right place. Be sure to stay on top of everything by subscribing to the Rx for Success Medical Billing Blog here!

Also, check out our article on how to Successfully Outsource your Medical Billing , Tips That Can Help You Have a Thriving Practice During the Pandemic, and our End-Of-The-Year Checklist for Medical Offices

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