Geisinger Delayed Care for Insurance Check

By Walter F.Roche Jr.

The Geisinger Community Medical Center violated a federal law when it delayed care to a half dozen patients to get pre-authorization from their insurance carriers.
Surveyors from the state Health Department concluded that the delays in care at the 273 bed Scranton facility violated the Emergency Medical Treatment and Active Labor Act.
The inspection, the result of an unannounced on site November visit, found that in six of 20 cases reviewed, care was delayed by up to a full day awaiting pre-authorization from the individual insurance carriers. The six were seeking admittance to the hospital's behavioral health unit from referring hospitals.
"A participating hospital may not delay providing appropriate medical screening," the report states, "in order to inquire about the individual's method of payment or insurance status."
The report notes that the law does not bar health facilities from following reasonable registration procedures as long as those procedures do not "unduly discourage individuals from remaining for further evaluation."
Three of the six required specialized psychiatric care, according to the report.
In at least two of the cases reviewed, admission was delayed for a full day awaiting insurance carrier approval.
The hospital filed a plan of correction including a re-education program for emergency room staffers and an audit system to assure compliance. A hospital spokesman said the facility amended its procedures for handling transfers from other facilities thus avoiding any delays in care.
"We’ve taken steps to rectify that issue, which was related to patient transfers from outside facilities. We have amended our registration process for accepting transferring patients to reduce the risk of delaying treatment, and continue to work with the Department of Health to ensure our compliance with such requirements," the spokesman wrote in an email response to questions.


The hospital also revised its patient intake forms to eliminate the section requiring insurance coverage information.
Contact: wfrochejr999@gmail.com