As a medical student and EMS provider, I agree with all of the above except "In some hospitals, they won't even begin to treat you". Unless you end up at the rare hospital that doesn't accept Medicare, the ED's are required (by EMTALA) to provide a screening examination and treat any patient with an emergency medical condition. For example, any ED should be able to provide you initial care if you're complaining of chest pain (EKG, Chest X-Ray, Nitroglycerin, Aspirin etc). That said, if you're actually having a cardiac event, you'll need to be at a cardiac center to actually get definitive treatment, so the smaller outlying hospital will call an ambulance to transport you to the appropriate facility.