What an emergency room owes you, and what it does not.
Two federal rules decide most of what happens to someone who arrives at an emergency room without money. Knowing them changes what you can ask for. Neither of them makes care free, and this card will not pretend otherwise.
01
An emergency room has to examine you, whether or not you can pay
Any hospital that takes Medicare and runs an emergency department must give you a medical screening examination when you ask for one. They cannot ask about insurance first and refuse based on the answer. This applies regardless of insurance status, immigration status, or ability to pay.
WHAT IT DOES NOT DO
It is a duty to examine and stabilise, not a duty to treat you for free. You can still be billed afterwards, and often will be. It also does not cover non-emergency or follow-up care.
WHAT TO ACTUALLY DO
You do not have to argue or cite anything. Asking to be seen is enough to trigger it.
Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. §1395dd
02
If they cannot treat you, they have to arrange the transfer
Once an emergency condition is found, the hospital has to stabilise it. If they do not have what you need — a catheterisation lab, a stroke unit — they must arrange an appropriate transfer to somewhere that does. Sending you away untreated to find your own way is the violation.
WHAT IT DOES NOT DO
The obligation ends once you are stable. After that point they can discharge you, and a stabilised patient is not the same as a treated one.
EMTALA, 42 U.S.C. §1395dd(b)–(c)
03
Every nonprofit hospital must have a financial assistance policy
Around three in five US hospitals are nonprofit. In exchange for paying no federal income tax, each one is required to have a written financial assistance policy, publish it, and apply it. Ask for the financial assistance policy by that name, or for the "charity care application".
WHAT IT DOES NOT DO
It applies to nonprofit hospitals. For-profit hospitals are not covered by this rule, though many have their own programme, and public hospitals run separate schemes. Federal law also sets no income cut-off — each hospital picks its own, so eligibility genuinely varies by hospital.
WHAT TO ACTUALLY DO
Ask financial counselling or the billing office for the financial assistance policy in writing. Get it before you agree to a payment plan, because a signed plan is harder to undo than an unpaid bill.
You can still apply after the visit, for months afterwards
The most common and most expensive mistake is assuming it is too late. A nonprofit hospital has to accept and process a financial assistance application for 240 days from the date of your first bill. Applying after treatment is normal, not a special case.
WHAT IT DOES NOT DO
The 240 days run from the first billing statement, not from the visit, and not from when the debt is sold. Missing the window means losing it.
WHAT TO ACTUALLY DO
Apply even if the bill has already gone to collections. Ask for the application in writing and keep the date you sent it.
They have to check whether you qualify before coming after you
Before a nonprofit hospital can take aggressive collection action, it has to make reasonable efforts to work out whether you were eligible for financial assistance. It also has to warn you in writing at least 30 days beforehand, and it stays responsible for what a debt collector does on its behalf.
WHAT IT DOES NOT DO
This restricts the aggressive actions specifically. Ordinary billing and ordinary reminders continue throughout.
WHAT TO ACTUALLY DO
If a collection notice arrives and nobody ever offered you the financial assistance policy, say so in writing. That is the point the rule exists for.
This is a plain-language summary of published law, not legal advice, and Relay Arc is not a law firm. Hospitals set their own eligibility rules within these requirements, so the only way to find out what you qualify for is to ask that hospital for its policy in writing.