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Law prohibiting freestanding emergency rooms from accepting Medicaid, Medicare limits patient options

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Code 3 Emergency Room, a stand alone facility in Rockport, got a surge of patients after Hurricane Harvey but the law prohibits them from accepting Medicaid or Medicare. Code 3 Emergency Room, a stand alone facility in Rockport, got a surge of patients after Hurricane Harvey but the law prohibits them from accepting Medicaid or Medicare.
The ER has provided $1.3 million in health care services since Harvey that they have not been reimbursed for. The ER has provided $1.3 million in health care services since Harvey that they have not been reimbursed for.
Physicians at Code 3 are working with members of Congress to try to get disaster funds and change the law that prohibits them from accepting Medicaid or Medicare. Physicians at Code 3 are working with members of Congress to try to get disaster funds and change the law that prohibits them from accepting Medicaid or Medicare.

When the only hospital in Aransas County shut down due to damage from Hurricane Harvey, stand alone emergency rooms became essential for providing care. However, it is against federal law for those facilities to accept Medicaid or Medicare.

That leaves Medicaid and Medicare patients with few options. They need to decide whether to drive miles to a facility affiliated with a hospital, or pay out of pocket. 

Physicians at the Code 3 Emergency Room in Rockport did not expect to be flooded with patients after Hurricane Harvey hit, but that's what happened, when the storm damaged and shut down the county's only hospital. Code 3 got more than a thousand patients in the month after the storm. 

"We've now taken on on an entire area of the coast of Texas here that doesn't have access to an emergency room other than us," Dr. Carrie de Moor, M.D., CEO of Code 3 Emergency Room, said. 

Many of their patients are on Medicaid or Medicare, but under current federal law, that insurance cannot be used at stand alone emergency rooms, like Code 3 ER. 

Since the facility cannot get reimbursed, they give those patients two options: pay out of pocket, or go to another facility. 

However if a patient's life is at risk, Code 3 physicians are required by Texas law to provide care.

And they do. They just do not get paid for it. 

"We take care of them, we stabilize them, we call a helicopter. They get paid for it, but we don't, for doing all the care up to it including calling the helicopter," Dr. Justin Hensley, M.D., Medical Director of Code 3 Emergency Room, said. 

He adds that the lack of coverage can also create life-threatening situations. If a Medicaid or Medicare patient calls 911, the ambulance will not bring them to the a stand alone ER like Code 3, because that trip would not be covered. Instead, they go to Portland or Corpus Christi. 

"The time delay for evaluation by physician can be the difference between life and death," Dr. Hensley said. 

Now the physicians are working with members of Congress, trying to get disaster funds to treat Medicaid and Medicare patients.

Whether they are covered or not, the clinic is treating those patients in emergencies. Since Harvey, they have provided $1.3 million dollars worth of health care without reimbursement.

"No business can survive if you're not getting compensated for 70 percent of your business," Dr. de Moor said. "We need that assistance to make sure people in this county still have access to care that they deserve."

The physicians at Code 3 Emergency are also working with members of Congress to try to permanently change this policy. They say the best way to get the federal law changed is for patients and others to write to their Congressmen and Senators.

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