What an Emergency Room Must Do for You

The obligation, precisely

Any hospital emergency department participating in Medicare — effectively all of them — must provide a medical screening examination to determine whether an emergency condition exists, and if it does, must stabilize it before discharge or transfer.

Three things are explicitly outside the calculation: your insurance, your ability to pay, your immigration status. A hospital may not delay screening to run a payment check.

What it does not promise

It is not free care. Stabilization is required; payment is settled afterward. That’s where hospital financial assistance comes in, and in New York the ceiling on what an uninsured patient can be charged is set by statute rather than by the hospital’s mood.

It is not ongoing treatment. The obligation covers the emergency, not the follow-up. Planning the follow-up before you leave is the part people skip — ask at discharge who you should see and how soon.

It is not a guarantee of admission. If screening finds no emergency condition, the obligation is met.

What to do at the desk

Registration will ask for identification and insurance. Answer what you can, and if you have neither, say so plainly: “I don’t have insurance.” That sentence does not change your right to be seen, and it starts the conversation about financial assistance earlier rather than later.

You can decline to provide a Social Security number. Care does not depend on it.

If you are told to leave before being seen, ask directly: “Am I being refused a medical screening examination?” That phrasing names the obligation, and it is the sentence to repeat if the answer is unclear. Refusal is reportable to the Centers for Medicare & Medicaid Services and to the New York State Department of Health.

Afterwards: the bill

Order of operations, unchanged:

1. Request an itemized bill.
2. Apply for financial assistance and ask that collection activity pause.
3. Check whether an out-of-network physician treated you inside an in-network hospital — a classic protected situation under surprise billing rules.
4. If you were uninsured and low-income, remember the floor: at or below 200% of the federal poverty level a New York hospital may not charge out-of-pocket costs at all.

For what an emergency visit is actually built from — facility fee, physician fee, everything billed separately — see the anatomy of an ER bill.

If you are undocumented

The obligation is identical. Hospital staff are health care workers, not enforcement. Emergency Medicaid exists for exactly this gap: it can cover treatment of an emergency condition, including delivery, for people who meet income rules but not immigration rules, and it is applied for at the hospital. More: immigration status and medical care.