E-mail updates
Follow on Twitter
Subscribe to RSSUp to half of the people who are treated at hospital emergency departments and trauma centers are under the influence of alcohol, experts say. That may be a sobering statistic, yet a recent study found that emergency departments can capitalize on this “teachable moment” to discourage problem drinking in the future.
But laws in more than half the states permit insurers to deny payment for medical services related to alcohol or drug use and that can derail hospitals’ best intentions, experts say. Faced with the prospect of not getting paid for care, some emergency department personnel may sidestep the problem by simply not testing patients’ blood or urine for alcohol.
In the study, published online in the Annals of Emergency Medicine in March, nearly 600 emergency department patients who were identified as hazardous or harmful drinkers (defined for men as drinking more than 14 drinks per week or more than four on any single occasion, and for women as more than seven weekly drinks or three on any one occasion) took part in a seven-minute interview. During the interview, an emergency department staff member discussed the link between a patient’s injuries and alcohol, as well as guidelines for low-risk drinking, and encouraged the patient to discuss what was stopping him from drinking less and to set a drinking goal.
Compared with those who received standard care, patients who took part in the sessions reduced their average number of weekly drinks significantly as well as their episodes of binge drinking and drinking and driving over the next 12 months.
“In the emergency department on a weekend, all the cases may be drug or alcohol related, and yet we don’t do” screening and intervention, says Gail D’Onofrio, the study’s lead author who is chair of emergency medicine at Yale University School of Medicine. “Our goal is to normalize this in the emergency department.”
Although some of the nearly 4,000 emergency departments screen patients for drug or alcohol use, it’s not required. Level 1 and 2 trauma centers, however, which are typically equipped to handle emergency patients suffering from serious injuries sustained, for example, in major car accidents, must screen for problem drinkers. Level 1 trauma centers must also be able to provide counseling.
Such screening and counseling can be effective, says Larry Gentilello, a trauma surgeon who has published studies on injury prevention and substance abuse.
“Most of the people who are injured don’t need to go into treatment,” he says. “They aren’t alcoholics or alcohol dependent. That’s why one counseling session can help them by talking about the risks of drinking.”
The extent to which so-called alcohol-exclusion laws deter emergency medical personnel from screening and counseling patients for alcohol or drugs is unknown.
The laws have a long history. Since 1947, more than 40 states have passed measures allowing health plans to refuse to pay for care if the patient’s injuries occurred while he was under the influence of alcohol or, in some states, drugs, say experts. As people came to understand alcohol addiction and the possibility of treatment, however, it became clear that the laws were counterproductive. In 2001, the National Association of Insurance Commissioners recommended against them.
Since then, at least 15 states have repealed or amended their laws and now prohibit exclusions of coverage for drinking or drugs, according to data from the National Institute on Alcohol Abuse and Alcoholism. Maryland and the District of Columbia are among them; Virginia’s law remains in place.
Regardless of state law, self-insured companies that pay their employees’ health care costs directly can refuse to cover employees for alcohol-related claims.
The laws have ensnared both problem and occasional drinkers.
Gentilello describes the case of a Seattle woman who was celebrating her 25th wedding anniversary and had a few glasses of champagne at dinner with her family. It was a rainy night and she was dressed up and wearing high heels. As she and her husband tried to hail a cab, she tripped on a curb, fell and broke her ankle. In the emergency department, her chart noted that she had a few drinks. Her insurer refused to pay. Washington subsequently adopted a prohibition on alcohol-related claims exclusions in 2004.
It’s unclear how frequently insurers continue to apply such laws to avoid paying claims. Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade organization, says the group doesn’t know what member practice is. Cynthia Michener, a spokeswoman for Aetna, says that “to our knowledge” the company doesn’t apply such exclusions. Other insurers, including UnitedHealthcare and Humana, didn’t provide information about their practices.
But a professor who has written about such laws says there are indications that health plans continue to use them to deny payment.
“There are tons of these cases,” says Sara Rosenbaum, a professor of health law and policy at George Washington University’s School of Public Health and Health Services. “The only evidence we have suggests that these cases go on.”
“There’s no reason to think that insurers, eager to hold down costs, wouldn’t continue” to deny payment based on such exclusions, she adds.
Related:
- Vegas hangover treatment bus: Is IV flush safe?
- Daily drink may reduce stroke chance
- 17 percent of US adults binge drink
Leave a Comment:
You know I hate those vegans who have their nose in the air and weigh 67LBS. Their arrogant attitudes! So if they get sick from malnourishment screw 'em!
(I don't really but the line used to be drawn in the sand. We ran past it decades ago!)
If you read the "fine print" of an insurance policy it would seem an insurance company can find grounds for refusing to pay for just about anything it wants to.
Insurance companies have no problem taking your money, but when it comes to giving any of it back, they slam that pocketbook closed as fast as they can.
What about people who eat too much? Should they be denied also? Or how about smokers? What ever the reason you end up in a ER, all people deserve to be treated well. Making assumptions for reasons why a person may end up in the ER could be very un-ethical or immoral. When insurance companies guard their bottom line by denying claims they transfer the burden to the innocent. In other words this person's family or children are forced into even more hardship than that already brought about by the sickness.
Insurance companies are ruining this country, we cant do anything without first thinking how our insurance may react. They are taking our liberty and freedoms and making astonomical amounts of money in the process.
I drink a 12 pack of Bud Lite daily, and have for 20 years. Only once did I hurt myself. I stubbed my big toe. Hurt for a month.
Lani,
If you DO drink a 12 pack of Bud Lite daily, you very definately have a problem (both health and insurance wise).
I hope you don't drive after or while you're driving!
Nope, don't drink & drive, even had my liver checked in March due to elevated enzymes, they found nothing, no scarring, just a little fat........Drink up !! ..............
No, they found elevated liver enzymes, you moron.
Lani ... that's a lot of alcohol by any measure. Elevated enzymes suggest a problem so not sure what they specifically "checked" after finding the elevations but that much alcohol daily definitely increases your risk for liver damage over time. Also many don't realize it but alcohol does much more to one's body than just damage the liver. Ultimately, it's your choice.
my liver enzymes are also high; however, I don't drink (not even socially) our bodies just process food and liquids differently.
@ RackNStack. Thanks for pointing out the obvious, but elevated enzymes can also be caused by medication, obesity, etc. After 20 + years of Booze my enzymes were only slightly elevated, There are some people after 20 years of beer that develop cirrosis...It's all a gamble anyway. Some people smoke all their life and never get cancer........
@ Mike P101. They did an ultrasound image. Liver was of normal texture, size, no scarring.
How bout denying lung cancer treatment if the patient smokes? or diabetes management if the patient is obese? Insurance premiums should directly reflect lifestyle and personal choices. If you choice to eat crap, smoke, not exercise, be prepared for a hefty fee.
I am surprised something like this is not already in Obamacare. We will not treat patients that bring diseases upon themselves. You have diabetes and its because you are obese so sorry its a no go, your fault. Smoke? Don't even bother coming in. Smoking causes virtually everything. Luckily if you were born with a disease you will be covered because Obamacare eliminated pre-existing conditions. I can hear the democrats in congress now "why didn't WE think of that?".
ok. if insurers don't have to pay for hospital visits when you are drunk, does that mean we don't have to pay premiums when we're drunk too?
Make a list of things the insurance companies don't think they should have to cover and then ask yourself what the HELL are they good for???
This is insane! More really unethical ideas coming from big business! When do we REALLY take a stand?
I agree with this to some degree. If you are stupid and doing something ILLEGAL (drinking and driving and have an accident where you get hurt) then I don't think that your co-workers should have to shoulder the costs of your stupidity. What some people don't realize is that when a health plan is "self funded" that means that your employer pays 100% of the cost of your bill. The insurance company manages your benefits, but the risk does not lie with them covered. They should have every right to say no to paying that bill. But if you are drinking and have an accident, like you trip over a curb, that is not illegal and should be covered. I know that is how my policy with my BCBS policy is written.
Pretty soon it will be to the point that there is no point in having health insurance if they are going to be able to exempt so many things. Now it's alcohol, next will it be issues caused by smoking or being exposed to smoke? Will they soon stop covering overweight people because any issues they have must come from being big, right? How about not covering people who eat meat anymore because it can cause heart disease from high cholesterol? (Don't attack that statement -- I'm a meat eater -- just saying that insurers could try that argument.)
There is a difference between an alcohol caused injury and an injury that happens when you are legally ingesting alcohol, such as the woman at dinner example in the article. This is criminalizing alcohol use the same as prohibition and that was repealed. This global exclusion of treatment laws are not legal or ethical.
As an ER nurse, and have seen wayyyyyy too many drunks brought in to the ER....I am seeing more and more drunks getting their driver's license revoked and for some....permanently due to repeated offenses. Drugs are a different bag and I can't tell you how disgusted it is to see a mean drug user pushing, slapping, biting anyone that gets close to them. Personally, not sure why the police bring them to the ER, take them to jail. There is nothing we can do for them except take a blood sample and "Yup"...there's cocaine showing up in the tox screen...so what exactly is it that you want the ER to do for someone else's messed up life. Stay home. "Where is the compassion" you may be asking yourself. After 30 years of being spit on, bit, slapped, punched, a fractured arm, threatened with a gun and knife.....how's your job?
So let them die from alcohol intoxication? Suppose it was a child who was abused by the stepfather by drowning him in whiskey? Let's not treat people who OD? I guess let them all die and the insurer will be all the happier too.... Let's all bend over and get F*CKED by the insurance companies and their lobbyists making up the laws for their benefit.... Go capitalism!!!
As a ER nurse with 22 years experience. Educating an Intoxicated patient is a unrealistic Goal at the time they are Intoxicated. It's scary to me to think that someone may not call an ambulance or bring in a loved one who needs treatment when they are intoxicated because of insurance. Lots of people choke to death while passed out. We as a country have way more abuse of the ER than alcohol related visits. Try hang nails and diaper rash.
if it's not required why wouldn't anyone simply say "don't run alchohol or drug tests on me"? if they come back positive i have to pay for the whole bill including the test on alchohol and drugs and therefore i do not want you to test for it as i am not willing to pay for that test. if they run it anyway then you can at least refuse to pay that part as you did not authorize nor want it done.
Anybody ever hear of Alcoholism? It's a disease and should be treated as one.
Between cigarettes and booze, you're probably looking, at least, at 25% of our total health care costs in this country. Obesity another 25-40%.
Countries like Sweden and Denmark don't have high health care costs not because their doctors take better care of them. It's that they abuse themselves less.
I'd personally rather see food reform before health care reform, because health care costs are going to continue to skyrocket as long as people continue to shove crap into their mouths.
I went into the medical field to save lives not to be the alcohol police. Testing my patient for the presence of drugs or alcohol has nothing to do with medical treatment unless they have alcohol poisoning or signs of a drug overdose. I am not going to help insurers find yet another excuse not to pay claims. I would much rather states and insurers find a way to get the non emergent stuff OUT OF MY ER!!!!!!! Like sundowning elders or people with colds, ear infections, etc etc etc.
insurance companies refuse payments alot of times before you appeal. The majority of the time they will pay if you appeal several times.
"Up to half of the people who are treated at hospital emergency departments and trauma centers are under the influence of alcohol, experts say." This is completely irresponsible reporting -- the percentage is much, much smaller than half, so saying "up to half" completely exaggerates the problem.
The source that the author cites actually credits this "statistic" back to this link: (link removed) There it states that just under 50% of adult patients admitted for TRAUMA are under the influence of alcohol. The author makes it sound like half of everyone who goes to hospital EDs is under the influence, but the fact is that adult trauma patients only make up a portion of ED visits.
Just another example of how you barely need a GED to author articles that go on the internet...
Edit: So, the link was automatically removed. Fantastic. The following should provide you with enough information to find the study if you're so inclined:
The effects of alcohol abuse on readmission for trauma
Rivara FP, Koepsell TD, Jurkovich GJ, Gurney JG, Soderberg R.
JAMA. 1993 Oct 27;270(16):1962-4.
PMID: 8105114 [PubMed - indexed for MEDLINE]
Most reporters and even people don't know the difference between an ER and Trauma admission. There used to be medical writers and editors but the news companies cut those when they were placed in the entertainment division. Long gone are the serious journalism days of Edward Murrow and Walter Cronkite. Now we get "news" reports that used to be considered editorial columns and they treat what's coming up on TV the next night as news when it used to be a commercial.