Ive seen some wierd things in the ED. But, if the patient came in, we are obligated by law to take care of them, even for an RX refill. We just code it and bill it. If the carrier doesn't pay, we bill the patient. If the patient doesn't pay, we send them to our collection agency.

I do get a good laugh when their claim is denied and we bill them, then they call us. They curse, scream and yell that we are ripping them off. I just let them go and when they're done, I simply tell them that we did not force them to go to the emergency room for a prescription refill. They then yell that they will file a complaint with the State. I just thank them for the call. I then smile, and key their account to go to my collection agency with instructions to report this to the credit bureaus where it will sit for 7 years and they can't get credit.

As they say in Klingon - Revenge is a dish best served cold.
(Actually this is from Moby Dick but Star Trek did it better.)