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Careful History Taking: Barrier to Insurance No Longer?

As a pediatric emergency physician in Northern Virginia, I have the good fortune to work with an amazing staff in a busy pediatric emergency department (ED) that sees a wide range of patients with both minor and life-threatening illnesses.  Of note, we have a wonderful electronic medical record (EMR) that allows us to see past visits, lab tests, and medical problems.

My last shift was an overnight during which I treated approximately 35 children.  About 2/3 of these children had medical problems listed in the EMR.  Many children had a history of asthma, several had febrile seizures in the past, and a few had more complicated chronic illnesses such as congenital heart disease or hemophilia.

Because I work in an ED, the only time I pay attention to insurance status is when I’m attempting to arrange follow-up for my patients.  EMTALA laws ensure that all patients receive emergency care regardless of insurance status.  In the ED, patients are treated first and asked about insurance later.  I have no idea what an actual visit to our ED costs, but I know it must be more than an uninsured patient can afford.  Rarely do the parents of our patients ask about the cost, their first concern is their sick child.  But I often wonder how burdensome the cost of the visit must be when the bill arrives a few weeks later.

Our EMR and record of past medical problems is a wonderful asset when I’m treating a sick child.  Often the families are stressed, and forget many of the pertinent details, and this way nothing is missed.  But could this same EMR be a barrier for these children when they become young adults and are trying to obtain their own insurance?  Could the adorable 3 year old who is wheezing in room three, have been denied insurance as an adult because I wrote in the medical record that she has asthma? Will the six-year old hemophiliac in room five who is bleeding from a minor abrasion after wrestling with his cousin be denied insurance when he’s reached adulthood?  I am thankful that because of the health reform law, they can no longer be denied insurance for a pre-existing condition.  With the new law, I do not have to worry that my careful history taking will harm their future.