Ethan Rhodes
Patients and their families have the right to request a transfer to another hospital, but the hospital does not have to agree. When considering a transfer, it is important to first determine where you would like to transfer and whether the facility is covered by your insurance. The patient's physician of record, the current attending physician, and the potential admitting physician from the new hospital will then discuss the patient's diagnosis and condition to determine whether a transfer is medically justified. If a transfer is approved, the transferring hospital must provide all relevant patient documents and ensure the transfer takes place with qualified personnel and appropriate transportation equipment.
| Characteristics | Values |
|---|---|
| Patient rights | Everyone in the U.S. is protected by the Emergency Medical Treatment and Labor Act (EMTALA) |
| Patient actions | Patients can ask their preferred hospital to be admitted, but the hospital doesn't have to agree |
| Transfer necessity | Transfers are often related to concerns about the quality of care and breakdowns in communication |
| Transfer process | The patient's physician of record, the current attending physician, and the potential admitting physician from the new hospital are involved in the transfer process |
| Transfer justification | The transfer must be medically justified or needed, taking into account scientific evidence, the patient's diagnosis, and condition |
| Insurance | Consulting with the insurance company is crucial to understand coverage for hospital transfers and potential out-of-pocket costs |
| Stabilization | A physician must certify that the benefits of a transfer outweigh the risks, and the patient must be stabilized before the transfer |
| Transfer requirements | The transferring hospital must provide medical treatment, send patient documents, and ensure qualified personnel and appropriate transportation equipment |
| Receiving hospital | The receiving hospital must have space available, qualified personnel to treat the patient, and agree to accept and provide treatment |
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What You'll Learn
Patients can request a transfer but the hospital can refuse
Patients or their loved ones can request a transfer to another hospital, but the hospital can refuse the request. This is because transferring from one facility to another is not always straightforward. There is no single authority or agency that can be approached to facilitate the transfer. The patient's care team must find an accepting physician at the new hospital to ensure that the patient's needs can be met.
When a patient requests a transfer, various individuals are involved in the decision-making process, including the patient, their family, the patient's physician, the current attending physician, and the potential admitting physician from the desired new hospital. The medical discussion considers the patient's diagnosis, condition, and related scientific evidence to determine whether a transfer is medically justified or necessary. This medical advice is then conveyed to the hospital managers, who make the final decision.
Before approving a transfer, the receiving hospital will typically seek answers to two fundamental questions: Does the patient require continued inpatient care? Could the transfer likely change the patient's outcome, given their current disease stage and trajectory? Additionally, the availability of specialized services or equipment at the current hospital may influence the decision to refuse a transfer request. For example, if a patient with severe burns requests a transfer to a hospital that does not have a specialized burn unit, the current hospital may refuse the request.
It is important for patients and their families to consult with their insurance company before initiating a transfer request. Different insurance plans have varying coverage for out-of-network hospitals and ambulance transportation costs. Understanding these financial responsibilities beforehand can help prevent unexpected expenses. Furthermore, some insurers require proof of medical necessity or a physician's approval for the transfer.
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Transfers require an accepting doctor at a new hospital
Patients have the right to transfer to another hospital. However, transferring from one facility to another can be difficult. When a patient has to remain in a hospital under protest, the family, friends, or medical agent should ask for a social worker or patient relations professional to step in as an intermediary between all parties. Usually, by the time a family wants to change hospitals, there has been some type of issue involving a breakdown in communication.
When considering a transfer, the first and most important thing to do is to find an accepting physician at the new hospital to ensure the patient is landing in a safe environment that's ready to take on their needs. The patient's care team will need to find an accepting doctor at the new hospital; it is not the current doctor's responsibility to find a new doctor for the patient. The receiving hospital will look for affirmative answers to two basic questions before approving the transfer: Does the patient require continued inpatient care? Could the transfer likely change the patient's outcome given their current stage of disease and trajectory?
The patient, their family, the patient's physician of record, the current attending physician, and the potential admitting physician from the desired new hospital are all involved when the need for a transfer is under question. The medical discussion considers related scientific evidence and the patient's diagnosis and condition to determine whether a transfer is medically justified or needed. This medical advice is conveyed to the hospital managers to guide their decision, which is then relayed to the patient.
A key step to any hospital transfer is consulting with your insurance company. You'll want to find out if the preferred hospital is in-network with your insurer and whether it will cover ambulance transportation if that's necessary. While Medicare and all major medical health insurance plans will provide coverage for hospitalization and ambulance services under certain circumstances, the details of coverage can differ significantly, and you may face out-of-pocket costs. Some insurers also require proof of medical necessity or a physician's approval.
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Transfers for a second opinion are common
When considering a transfer, it is crucial to determine whether the patient requires continued inpatient care and if the transfer could potentially change the patient's outcome given their current disease stage and trajectory. In most cases, seeking a transfer can improve communication between the provider team and the patient, even if the transfer doesn't ultimately take place.
Before approving a transfer, the receiving hospital will typically assess whether the patient's condition requires ongoing or additional supportive care and if their health will deteriorate without such treatment. Additionally, the transferring hospital must ensure that the receiving hospital has the necessary space, qualified personnel, and agreement to accept and treat the patient.
It is also important to consult with your insurance company to understand the financial implications of a hospital transfer. Transportation costs, for example, are often not covered by insurance and can be quite expensive, especially when advanced ambulance services are required. Some insurers may also require proof of medical necessity or a physician's approval for the transfer.
In the United States, the Emergency Medical Treatment and Labor Act (EMTALA) provides legal protection for patients seeking transfers. EMTALA requires a physician to certify that the benefits of a transfer outweigh the risks and that the patient's condition is stabilized before the transfer occurs.
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Transfers require consultation with insurance companies
A hospital transfer may be necessary when a patient requires specialised care that the current hospital cannot provide. This could be due to a lack of specialised doctors or equipment. For instance, a patient with advanced pancreatic cancer sought a transfer from an acute care hospital to a cancer-focused facility for chemotherapy.
However, navigating a hospital transfer can be challenging, and there is no central authority to oversee the process. When considering a transfer, it is crucial to consult with your insurance company to understand your financial responsibilities. Transportation costs, for instance, are often not covered by insurance and can be expensive, especially when advanced ambulance services are required.
Bob Rees, chief sales officer of eHealth Inc., a health insurance broker, advises that patients consult their insurance company to determine whether the preferred hospital is in-network and if ambulance transportation is covered. While Medicare and major medical health insurance plans provide coverage for hospitalisation and ambulance services under specific circumstances, coverage details can vary, leading to unexpected out-of-pocket costs. Patients may need to submit a request for pre-authorisation, providing medical justification for the transfer.
Additionally, insurance coverage continues to play a role in determining which patients are transferred and which are not. Uninsured patients are less likely to be transferred to another hospital, as the costs of providing care are unlikely to be recovered. This disparity in transfer rates contributes to healthcare inequities, as certain patients may not receive the specialised care they need due to insurance status.
Therefore, when considering a hospital transfer, it is essential to consult with your insurance company to understand your coverage and potential costs. This step will help ensure a smooth transition and prevent unexpected financial burdens.
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Transfers must be medically justified
Transfers between hospitals must be medically justified to ensure the best care for the patient. The patient's diagnosis and condition are considered, along with scientific evidence, to determine if a transfer is necessary. This decision is made by the patient's physician of record, the current attending physician, and the potential admitting physician from the desired new hospital. The patient's medical agent, family, or friends may also be involved in the process.
A transfer may be deemed medically justified if the receiving hospital can offer a higher level of care or specialized treatment that is not available at the current hospital. For example, if a patient with severe burns requires treatment in a specialized burn unit, or if a patient needs advanced cardiac surgery. In these cases, the benefits of the transfer must outweigh the risks, and it must be determined that the patient's condition will not materially worsen during the move.
It is important to note that the patient's insurance company should also be consulted, as costs and fees associated with the transfer may be the responsibility of the patient. Transportation costs, such as ambulance services, are often not covered by insurance and can be expensive. Additionally, the patient's insurance plan may only cover certain hospitals or facilities, limiting their transfer options.
In the United States, the Emergency Medical Treatment and Labor Act (EMTALA) provides legal protection for patients requiring emergency medical care. EMTALA ensures that hospitals receiving Medicare funds, which includes almost 98% of US hospitals, cannot refuse to treat patients based on their insurance status. Under EMTALA, a hospital must provide a medical screening examination (MSE) to any person requesting care and stabilize any emergency medical conditions (EMCs). If the patient's EMC cannot be stabilized, the hospital must obtain the patient's consent and provide an appropriate transfer to another medical facility that can provide the necessary treatment.
In summary, transfers between hospitals must be medically justified, taking into account the patient's diagnosis, condition, and the availability of specialized treatment at the receiving hospital. The decision-making process involves multiple medical professionals and considers the benefits and risks of the transfer. Additionally, practical considerations, such as insurance coverage and transportation costs, play a role in ensuring a safe and efficient transfer.
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Frequently asked questions
EMTALA stands for the Emergency Medical Treatment and Labor Act. This law helps prevent any hospital emergency department that receives Medicare funds from refusing to treat patients. EMTALA also requires a physician to certify that the benefits of a transfer outweigh the risks.
A patient may want to transfer hospitals if they feel they would receive better care at a different facility. For example, a patient with a specific condition may want to transfer to a hospital that specializes in treating that condition.
To transfer hospitals, patients or their loved ones can ask their providers whether a transfer is necessary and would benefit the patient. The patient's current provider must then order the transfer request. The patient must also have an accepting doctor at the new hospital. It is important to consult with your insurance company to understand the costs associated with the transfer.
Yes, a hospital can refuse a transfer request. The hospital does not have to agree to a transfer request, especially if it does not have specialized services or capabilities that the patient requires.
