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When Reimbursement is Required for Emergency Medical Services in Nevada

When Reimbursement is Required for Emergency Medical Services in Nevada
Someone who calls 911 in response to a medical emergency can be unpleasantly surprised when a bill arrives for the cost of the ride and other services provided by emergency medical professionals. A bill for reimbursement can happen even for someone who has health insurance coverage. The legal framework surrounding emergency services is complicated, involving state and federal health care laws and insurance regulations, as well as the often-unpredictable interaction between different service providers.

Federal law requires coverage of emergency services by group insurers, but leaves a gap

The federal Patient Protection and Affordable Care Act (the “ACA”) introduced important changes to how insurers treat emergency services. Under Section 10101 of the ACA, group health plans are required to cover emergency services without pre-authorization from the insurer, and without regard to whether the service provider is a participating vendor under the plan. The insurer is required to compensate the provider at the same level as in-network providers. Although the ACA protects patients in group insurance plans from paying the full bill for things like ambulance rides, the patient can still be billed for the gap between the ambulance company’s rate and the insurer’s in-network rate, which typically is lower than the “market” rate. So-called “balance billing” is a common source of complaints not just for ambulance rides but also for hospital care. The complexity of the ambulance business further muddies the math, because providers are often free to decide for themselves how to charge for their services and can potentially pile up numerous fees for short rides.

Nevada is still grappling with how to regulate balance billing within the state

Patient advocacy groups have been pushing for adoption of legislation around the country to address unfair balance billing practices, as well as surprise billing (where a patient receiving care at an in-network hospital is charged for out-of-network services provided to the hospital by an outside service). Thus far Nevada has not taken steps to close the gap left open by the ACA. Because the ACA itself is a controversial law that may be changed or repealed, the outlook is unclear as to whether balance billing practices will come under tighter control. For patients who are faced with a huge surprise bill there may be several options for contesting it. The types of options that are available may depend on the kind of insurance the individual carries—the insurer may require billing disputes to be handled through mediation or through an insurer-driven process. Or the emergency services provider may have had the patient sign a contract that may limit the patient’s options. An attorney may be able to provide guidance on how to resolve these problems.

Talk to a Las Vegas personal injury law firm about your reimbursement questions

For more than 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area protect their legal rights and recover compensation for personal injuries. If you have questions about how to dispute a large and unexpected bill for medical services, we may be able to help. For a confidential, no-cost attorney consultation, call us today at 702-388-4476, or ask us to call you through our contact page.

When Can EMS Professionals Use Force?

When Can EMS Professionals Use Force?
From time to time an EMS professional will encounter a belligerent or physically aggressive patient. Whatever the cause of the patient’s aggression—mental health challenges, alcohol or other substance abuse, or some other issue—for EMS the challenge will be to resolve the situation in a way that is safe for everyone involved and gets the patient the care he or she needs. Here are some things to keep in mind when making the decision to use force to restrain a patient.
  • A patient’s aggressive behavior may be a sign of a serious medical condition.

The first thing to bear in mind about someone who is behaving erratically or violently is that he or she may be experiencing a serious medical event that requires immediate intervention. A diabetic may become delirious due to low blood sugar levels, or a drug user may be experiencing symptoms of overdose or withdrawal. Such conditions aren’t always easy to identify in the field and can only be diagnosed properly once the patient is at the hospital. Using force to restrain a patient may be necessary to save his or her life. In legal terms, a patient can be deemed to give implied consent to treatment in emergency or life-threatening situations. Unfortunately, some situations will be clearer than others. A patient who is clearly delirious and unaware of what’s happening probably would want to be helped if in his or her right mind. But a slightly drunk patient who was just dumped by his girlfriend may simply be angry and may still have the legal capacity to refuse treatment.
  • Restrain with care.

Any time a person is restrained there is a risk of injury. In every event, it is best to begin with verbal engagement and only move on to physical methods if talking just isn’t going to work. There are a number of principles to bear in mind when using physical restraints. An EMS professional should never attempt to physically restrain a patient without police present. And care must be taken to ensure that restraints do not impede the patient’s circulation or breathing. Some EMS professionals have faced the threat of criminal charges after restraints suffocated their patients.
  • Report physical encounters.

EMS professionals who find themselves in physical altercations with patients need to protect themselves against civil and even criminal liability. Reporting the event to supervisors and, if applicable, a union legal representative, is an essential step to take as soon as possible after the event. Gathering facts while memory is fresh is important. This is especially the case if the patient suffered serious injury or death. In many cases it’s a good idea to talk to an attorney who is outside the employer/union relationship.

GGRM can answer your questions

For over 45 years the attorneys at Greenman Goldberg Raby Martinez have represented clients in the Las Vegas first responder community. If you have been in a situation that required force against an unwilling patient and you would like to discuss your legal risks and options, we are here to answer your questions. Call us today for a free attorney consultation at 702-388-4476, or reach us through our contact page.

Natural Disasters and First Responder Workers’ Comp

Natural Disasters and First Responder Workers’ Comp
During natural disasters first responders often rush toward the places of greatest hazard. Wildfires, severe weather, floods, and even earthquakes are among the disasters emergency personnel may face here in Nevada. And as we saw during the 2017 firestorms in California, from time to time Nevadans also go to other states to lend assistance to local crews. First responders may have questions about how Nevada’s workers’ compensation system protects them during these events.

Disaster declarations and workers’ compensation

Nevada’s industrial insurance law doesn’t specifically address natural disasters. But Nevada law authorizes the governor to declare a state of emergency in the event of a disaster “of unprecedented size and destructiveness.” Part of the rationale for this law is to ensure that the state can access federal resources to respond to crises. The governor used this authority last year to respond to severe weather in the state. The law also grants the governor broad authority to make and modify rules and regulations to, among other things, ensure the availability of emergency response personnel in times of crisis. NRS 414.060. Similar laws have been used in other states to facilitate provision of workers’ compensation benefits to first responders who are involved in disaster relief efforts. For example, in response to Hurricane Harvey the governor of Texas ordered workers’ compensation insurers to continue providing benefits to workers in affected areas, while also extending deadlines and expanding coverage in important ways. Under the right conditions, the Nevada governor could take similar steps. The Texas example highlights an important consideration during major disasters. In some cases a worker’s ordinary doctor or pharmacy may not be accessible. Workers with existing, covered conditions may need exceptions to their benefits rules, such coverage for out-of-network care or deadline extensions to account for lost power or disrupted communications. Absent a specific declaration from the governor or another authorized government official, workers in this situation may need help getting the care they need.

Workers’ comp has you covered

Even without an emergency declaration from the governor, Nevada’s workers’ compensation system should cover first responders who are injured during natural disasters while they are doing their jobs. Nevada’s industrial insurance system covers injuries that arise out of and in the course of a worker’s employment. NRS 616C.150. Police officers, firefighters, and EMS professionals who respond to natural disasters at the behest of their employers are covered. State law also explicitly provides coverage for volunteer firefighters, both nonprofessionals and professionals alike. Law enforcement personnel are typically authorized to take steps to protect the public even when they are off-duty, but it’s worth checking an employer’s policies to ensure that off-duty activities are covered. Nevada’s workers’ compensation law specifically provides coverage for injuries suffered out of state.  NRS 616C.190. First responders who go out of state to assist local agencies can do so knowing any injury they suffer will be covered. At Greenman Goldberg Raby Martinez we are proud of our long history of helping clients in the Las Vegas first-responder community resolve their workers’ compensation disputes. During emergencies insurers can become difficult to work with, due to high volumes or financial pressures. Having an experienced attorney staying on top of a dispute can make all the difference. For a free attorney consultation, call us at 702-388-4476 or send us a request through our site.

What Nevada EMS Professionals Should Know About Patient Do-Not-Resuscitate Rights

What Nevada EMS Professionals Should Know About Patient Do-Not-Resuscitate Rights
Emergency medical services professionals sometimes respond to calls from patients who are suffering from life-threatening conditions. When a patient’s heart stops while under EMS care, EMS personnel need to be mindful of the options Nevada grants its citizens to choose whether to be revived. Nevada recognizes two formal ways an individual can secure a medical order to not be resuscitated: the Provider Order for Life-Sustaining Treatment (POLST) and the Out-of-Hospital Do Not Resuscitate (DNR) order.

What is POLST?

The POLST program allows people who are extremely frail or suffering from terminal illnesses to make choices about the types of medical care they receive at the end of life. Nevada’s POLST statute, NRS 449.691 et seq., went into effect in 2013. A patient’s physician or other healthcare provider provides the POLST form, which to be valid must be signed by the physician and the patient or the patient’s legal representative. The Nevada Division of Public and Behavioral Health recommends that the POLST form be printed on hot pink paper to help it stand out. Patients are supposed to place their POLST form either near their refrigerator or next to their bed so EMS workers can find them quickly. Nevada POLST, a non-profit established to assist with the implementation of POLST in the state, provides good resources for EMS professionals to understand how the program affects them.

Do-Not-Resuscitate (DNR) orders

Unlike POLST, a patient does not need to be faced with a terminal illness or at the end life to obtain a DNR order. In fact, some individuals opt to have a standing DNR order as a personal preference. Like a POLST, a medically binding DNR order is obtained by completing a Do-Not-Resuscitate Identification Application, which must be signed by the patient’s physician and the patient or the patient’s legal representative. Upon receipt of a validly executed form, the state issues the patient an identification card that puts healthcare providers on notice of the patient’s DNR choice. Both a copy of the signed form and the ID card serve as binding medical orders. Some patients opt to wear bracelets or other distinct jewelry with DNR alerts printed on them. EMS personnel must follow specific guidelines with respect to treatments given to DNR patients.

Are EMS personnel legally liable for compliance with a POLST or DNR order?

Provided they are aware of it, EMS personnel are legally required to comply with a patient’s validly signed POLST or DNR order. NRS 449.695, NRS 450B.550. As such, it is best to ask the patient or the patient’s family or representatives if the patient has a POLST or DNR order, or if the patient is alone to check for a POLST form in the patient’s home or a DNR ID card in the patient’s wallet or purse. Personnel will not be held liable for complying with a POLST or DNR order, or providing care in violation of either if instructed to do so in another valid advance directive, or if the patient or a patient representative authorizes the treatment. NRS 449.6948, NRS 450B.540. EMS professionals should note that in the event a patient has both a POLST and a DNR, the document that was signed most recently must be followed. An EMS professional cannot refuse to honor a DNR or POLST. In either case, the patient must be transferred to another EMS provider or physician who is willing to honor the patient’s preferences. NRS 449.695, NRS 450B.550.

GGRM serves the Las Vegas EMS community

Greenman Goldberg Raby Martinez is proud of its long history of service to Las Vegas first responders, including our city’s EMS personnel. We are happy to answer your questions about how patient POLST and DNR orders affect your legal obligations. To speak to an attorney, reach out to us today at 702-388-4476, or contact us through our website.