Being stuck in the hospital is no fun, especially when you’re dealing with painful conditions or surgeries. However, sometimes you have to deal with a different type of distress, the dreaded feeling that this hospital isn’t the right fit for you.
If you find yourself second-guessing your situation, a hospital transfer may be the answer.
Why Would You Transfer Hospitals?
There are generally two broad reasons a patient might transfer from one hospital to another:
— The hospital can’t provide the care the patient needs.
— The patient or their family is dissatisfied with the quality of care being delivered.
The hospital can’t provide the care needed
This scenario — the hospital lacks the necessary or specialized expertise to provide care — is the most common, says Dr. Daniel Eiferman, a critical care surgeon with the Ohio State University Wexner Medical Center in Columbus.
For example, a patient might come in with a trauma injury from a major auto accident. The small hospital they arrive at, however, doesn’t have a trauma center. Or, let’s say a patient comes in while having a stroke, but the hospital doesn’t have a stroke center. A third scenario: A patient needs a specific procedure done, such as interventional radiology, but the hospital doesn’t have a radiologist on staff or the proper equipment to perform the procedure. In these situations, the hospital will transfer the patient to the appropriate facility — more on that later.
In some cases, transfers may occur in advance of a care situation a hospital isn’t equipped to handle. For instance, a patient could have complications needing greater medical intervention down the line, says Dr. Naeem Ali, medical director of the Ohio State University Hospital.
In some cases of labor and delivery, for example, if the doctor has reason to believe that there could be complications, the patient may be transferred to a hospital that has a more robust prenatal or neonatal unit. These units may be better positioned to handle high-risk deliveries and other care needs that can arise as that dynamic situation evolves.
The patient or family requests a transfer
In some rarer instances, a patient or their family may request a transfer if they aren’t happy with the care they’re receiving. Such transfers can become a little murkier and more challenging to achieve.
Ali, who also serves as clinical professor of internal medicine at the Ohio State University College of Medicine, refers to these as “transfers for a second opinion.” In such situations, the receiving hospital will look for affirmative answers to two basic questions before approving the transfer:
— Does the patient require continued inpatient care?
— Could the transfer likely change the patient’s outcome given their current stage of disease and trajectory?
While transfers related to concerns about the quality of care are often about a breakdown in communication between provider and patient, Ali says asking about a transfer can spur your current provider to step up how they’re communicating and may be enough to resolve the issues.
“More than 90% of the time, this can improve the engagement of the provider team even though a transfer might not be necessary,” he says.
Bringing up a transfer can also help providers and patients get on the same page about the current treatment plan and where they’re headed.
In all cases, facility transfers require the provider to order the transfer request, Ali says.
“Patients or loved ones can facilitate initiating this process by openly asking their providers whether a transfer is necessary and would benefit the patient,” he explains.
But ultimately, it’s up to the hospitals to sort out the transfer and how it will proceed.
Keep in mind, as well, that you must have an accepting doctor at a new hospital; it is not the current doctor’s responsibility to find a new doctor for you.
[READ: Health Questions to Ask Your Doctor]
How the Transfer Process Works
For whatever reason a transfer is requested, there’s a process for how to organize that move. Eiferman says every hospital has a central call area through which transfer requests are funneled.
When a hospital can’t provide the service needed, for example, someone from the hospital will contact other nearby medical centers that do offer that service and ask if they can accept a transfer.
“The accepting hospital then makes a decision about what to do. If they say no, the current hospital will have to continue to search for another hospital,” Eiferman explains.
A hospital may refuse a transfer request if it’s full or otherwise doesn’t have the capacity to care for the patient, he adds. While the transfer is being sorted out, the patient will continue receiving care at the first hospital.
In cases where the patient or a family member wants to initiate a transfer for reasons other than medical necessity, the patient or their advocate should reach out to their hospital case manager or social worker for assistance.
These professionals “are committed to advocating for you and your needs,” says Russell Graney, New York-based founder and CEO of Aidin, an online platform that helps connect providers, patients and payers to improve health care outcomes. “They’re experts in the health care system and know how to navigate its many complexities.”
Graney adds that you should be sure to “explain your concerns calmly and plainly and know they’re there to help you get what you need. Most case managers will have experience supporting patients in tricky situations and will offer counsel and advice given the specifics of your case.”
[See: What to Pack in Your Hospital Bag: A Checklist]
Second Opinions and eConsults
If you’re considering a transfer to a new hospital because you’re unhappy with the care you’ve received, Eiferman suggests pursuing another option first: asking for a second opinion.
It’s unlikely that there’s only one of your type of doctor in the hospital, he says, and chances are good another specialist can weigh in on your care plan.
Instead of being an affront to the treating doctor, asking for a second opinion is a sign of a patient who’s invested in their own care. Eiferman says most doctors welcome bringing a colleague into the care discussion and actively support patients asking for a second opinion, which he notes “every patient has a right to.”
If the treating hospital does not have another doctor in that same specialty on-site, you can arrange a telehealth consultation with a doctor at another hospital.
[See: 12 Signs You Should Fire Your Doctor.]
Does Insurance Cover Hospital Transfers?
A key step to any hospital transfer is consulting with your insurance company, says Bob Rees, chief sales officer with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
“Specifically, you’ll want to find out if the preferred hospital is in-network with your insurer and whether it will cover ambulance transportation, if that’s necessary,” he explains. “While Medicare and all major medical health insurance plans will provide coverage for hospitalization and ambulance services under certain circumstances, the details of coverage can differ significantly and you may face out-of-pocket costs.”
Rees adds that when you talk with your insurance company, you may need to submit a request for pre-authorization to ensure you’re covered before the transfer.
“This may involve filing a form and obtaining a letter from your doctor — and possibly medical charts — to demonstrate the medical necessity of the move,” he says.
Transportation to a new hospital may also be costly. Medicare, for example, doesn’t cover transportation for nonemergency situations, Ali notes. However, “if you are a Medicare member and you have Part B coverage, you will be transported to the nearest appropriate medical center and pay 20% of the cost,” he adds.
In short, make sure you understand your financial responsibilities before you take the plunge on a transfer, and that advice extends to considering other, less tangible costs.
“The biggest cost can be a cost to your health,” Graney says. “Ensuring the accepting facility is ready to deliver the needed care is most important, so your care and recovery aren’t negatively impacted by your transfer.”
Your insurer also may not approve a transfer, Rees notes. He adds, however, that you may be able to appeal a request for pre-authorization that your insurance company has turned down.
If your request is not accepted, Ali recommends asking why. The vast majority of requests are accepted, he says, because they are initiated by the treating physician for reasons of medical necessity. But in some cases, Ali adds, patients are refused a transfer because the hospital determines the change wouldn’t impact the patient’s outcome or the risks of moving the patient could worsen their condition.
The bottom line is that patients can ask their preferred hospital to admit them, but the hospital doesn’t have to agree, especially if it has nothing unique to offer — such as a specialized burn unit for a severely burned patient, for instance, or the capability to undertake advanced cardiac surgery when needed.
Selecting the Right Hospital in Nonemergent Situations
When it comes to selecting a hospital for care, if you have the luxury of time, Eiferman recommends selecting a hospital that handles a high volume of patients with the same condition as you.
“There are multiple studies in the literature about how patients have better outcomes at high-volume centers for high-risk procedures,” he explains. “If you need something that is high risk or not commonly done in your hospital, I think it’s very reasonable to say that you’d like to be transferred to a high-volume hospital.”
Not only does practice make perfect, but advanced care centers that deal frequently with a specific type of procedure or care plan have the appropriate staff and equipment, such as physical and occupational therapists, specialized nursing staff and the latest technology.
As the patient, you can ask if the procedure you’re being offered is something that’s performed commonly at the hospital that’s treating you. If the hospital doesn’t deal with a high volume of that procedure, that’s an opportunity to ask for a transfer or a consult with a physician who does more of those procedures, Eiferman says.
Transitioning Care
Moving from one facility to another — or even between doctors — is not unusual.
“Transferring care isn’t only for when something isn’t going right,” Graney points out. “Almost every health care journey includes transitions from one provider to the next. Hospital patients, for example, often need follow-up care after surgery or a serious illness.”
Moving you safely and securely to this next level of care is “one of the essential services your health care team should provide,” he adds.
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Where to Turn for a Safe and Efficient Hospital Transfer originally appeared on usnews.com
Update 03/26/24: This story was previously published at an earlier date and has been updated with new information.
