Emergency room staff consists of doctors, medical assistants and nurses. They are all well trained to handle the real medical emergencies. In case of misuse people get admitted to the emergency room for trifle problems like cough and cold or minor fever. Actually these illnesses can be treated by urgent care centers, and by getting admitted to an emergency room such people engage the staff of ER for themselves though there is no emergency at all. They don’t understand that by doing this they deprive a person of the special medical treatments who is actually in need of them.
What can You Call As a Medical Emergency?
Stroke, tightness or pressure in the chest, severe pain in abdomen, appendicitis, loss of consciousness, drug overdose, poisoning, asthma attack, car or motorcycle accident, any other type of accident, broken bones, severe burns, rape, child abuse, domestic violence, bleeding that doesn’t stop are some of the medical emergencies for which one has to get admitted to the emergency room.
In case of children below 3 months, fever more than 101° is also a medical emergency.
If the child turns pale or blue and breathing becomes slow then too it is a medical emergency and should get admission to the emergency room.
If a person goes to ER, for cough, cold and slight fever then s/he is misusing the facility and thereby wasting national emergency resources. Patients having insurance do not understand the seriousness of the situation, as they pay hardly anything from their pocket.
Here Prudent Lay person steps in. This is an individual who has a limited knowledge of medicines and health because of which s/he can be considered a “lay person”. This designation was created for checking whether an Emergency Room claim is being paid not according to the medical condition or diagnosis but on the apparent necessity of a “lay” person who has limited medical knowledge.
These people are employed by health insurance companies. The prudent lay person takes a look at charts of emergency room and determines whether there was a real emergency or not, with the help of his knowledge. Then s/he suggests to health insurance company, whether the reimbursement is to be done of total amount or in part.
So, from now on, beware of the Prudent Lay Person before getting admitted to the ER as you may not get your claim passed if made for small problems, and not really requiring emergency medical attention.