Reimbursement and insurance coverage in cases of suspected sexual abuse in the emergency department.
OBJECTIVE
To characterize third party payor types and rates of reimbursement for hospital costs in emergency department (ED) evaluations of preadolescents presenting as suspected victims of sexual abuse (SSA).


METHODS
Retrospective chart review, comparing a set of 186 SSA patients with 623 evaluated for upper limb fracture and cumulative reimbursement and insurance data for all patients presenting to the ED during a 12-month period.


RESULTS
A greater percentage of SSA patients was uninsured (N = 96, 52%) as compared to patients with fractures (N = 9, 1%); 23% of all ED billing came from the uninsured. Of the 96 self-pay SSA patients' bills only 4% reimbursement was received. Of the insured, a greater percentage of the SSA patients was covered by publicly-funded plans (n = 59, 66%) as compared to fracture patients (N = 327, 52%). A lower percentage of insured SSA bill reimbursement was received from publicly-funded insurance than from commercial insurance (28% vs. 58%).


CONCLUSIONS
Hospital costs of SSA patients are more often and to a greater degree underwritten by the hospital itself as a result of lower reimbursement and a higher percentage of uninsured and publicly-funded plans in that group, raising critical questions about how care for children with serious socially-based diagnoses is delivered and funded.
Kupfer
G M
GM
Department of Pediatrics, Children's Hospital of Philadelphia, PA, USA.
Giardino
A P
AP
D001134:Arm Injuries / Q000191:economics; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics*; D050723:Fractures, Bone / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D015143:Philadelphia; D017149:Private Sector / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States