Is it an
emergency?
The Prudent Layperson Law
A visit to the emergency department can
be a very stressful experience. Injury and/or illness combined
with the fear of the unknown can create tremendous anxiety in
patients and their families. This fear of the unknown should not
include whether the health insurance company will pay for the
patient's visit to the emergency department.
A common question that is asked by patients
who go to the emergency department is, "Would you please
contact my insurance company to see if it is ok for me to come
to the emergency department", or "Our insurance company
uses a different hospital as the preferred provider, is it ok
to be seen in this emergency department"?
The answers to these questions are: first,
we need to take care of the patient and determine if a true medical
emergency is present and if so, then quickly begin treatment.
Secondly, patients in the state of Louisiana should be aware of
the Prudent Layperson Law (Effective 8/15/97, R.S. 22:657 (D)
(2)).
In 1997, the Louisiana legislature passed
the Prudent Layperson Law. In simplest terms, this law states
that:
Insurance companies cannot deny claims
for payment made by any person who feels that they are having
a medical condition that may be an emergency and who seeks the
care of an emergency department. This includes conditions that
are later determined to be non-emergent. This law applies to all
insurance companies and any emergency department in the state
of Louisiana. Therefore, even if the emergency department is not
the preferred provider for a particular insurance company, payment
for the visit to the emergency department cannot be denied.
The Louisiana legislature realized that
patients who believe they have an emergency medical condition
should seek medical care from the closest or most appropriate
facility, and not attempt to drive across town to the preferred
provider's facility, potentially delaying care to the patient.
An emergency medical condition is any condition
that an average person feels that without medical attention they
could expect their condition to deteriorate to serious disability,
injury or death.
Patients often have difficulty knowing
if they should go to an emergency department for an exam and treatment.
Some conditions such as difficulty breathing may be obvious to
patients that they should seek medical attention. Other conditions
like fever or abdominal pain may not be so obvious. If an emergent
medical condition is suspected then there should be no delay in
seeking medical attention.
Seek emergency medical care immediately
if the following warning signs are seen:
- Chest pain lasting 2 minutes or more
- Uncontrolled bleeding
- Sudden or severe pain in any part of the body
- Coughing or vomiting blood
- Difficulty breathing or shortness of breat
- Sudden dizziness, weakness or change in vision
- Severe of persistent vomiting or diarrhea
- Change in mental status, such as confusion, difficulty in
waking someone.
- Upper abdominal pain or pressure
- Fainting
- Suicidal or homicidal feelings
If you have any questions regarding emergency
medical services in Ascension Parish please call St. Elizabeth
Hospital Emergency department (225-647-5000), or consult your
primary care doctor.
St. Elizabeth is the premiere emergent
care facility in Ascension Parish. It is open 24 hours a day with
highly trained doctors and nurses who are committed to the health
and safety of the residents of Ascension Parish.
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