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Will Your Emergency Room Visit be Denied? — 12 Comments

    • You’re very welcome! I am so happy you found it helpful. Please share with others who can benefit from the information.

  1. Article was helpful as I too am in this rotten dilemma following a **Xmas Eve ER visit** where I presented with severe abdominal \ lower back pain, high fever, vomiting, lethargy, relentless horrible cough that had persisted since early Dec. I had missed a week of work. I had been to 2 Urgent Care and 1 Primary Care visits since Dec 4 including a round of antibiotics and several prescription cough suppressants. Diagnosis could have been anything from bronchitis, flu, kidney infection to lung cancer. ER Doc performed XRay & Urology panel which to me indicates he heard my communicated symptoms.

    I was awake from 3am on Xmas Eve Googling symptoms, ER nightmares, etc. After 3 hours of careful consideration, I decided I could have something serious and potentially life-threatening thus requiring urgent medical care.

    The sad thing about our broken healthcare system was here I was at 3am in agony & a significant part of my ER / Not ER deliberation was being surprised with some monstrous bill and expecting my insurance company to deny, deny, deny.

    Final diagnosis was Bronchitis of Bacterial nature. Insurance denied solely off of Bronchitis code did not equal codes they classify as medical emergency.

    • Hi Eric,
      I’m so sorry to hear about your situation.I hope you will consider appealing the insurance denial. If insurance companies are to institute these policies for ER visits, they really need to apply a “prudent layperson” rule, meaning, would a prudent layperson seek care in the ER for this condition. I’m glad it was nothing too serious and I wish you the best with your healthcare journey moving forward.

  2. I’m in the same boat as others my er claim is being denied. About a month ago had a heart attack and went to the ER within 20 mins of arriving was in the Cath Lab for angioplasty and stints. Was in icu for about 36 hours and regular bed for about 48 hours. My insurance is denying coverage since we did not get approvals before the procedures we’re done, and they were not notified untill 48 hours after it was done. So they are denying my 100000.00 Er/Cath Lab/surgery/hospital stay bill. Not really seeing the point of paying for years and years of insurance never using it, then when you need it they just deny the claims anyways. Of course will be appealing it.

    • What a frustrating experience. I’m glad you’re ok. That is what is most important. The hospital’s failure to obtain preauthorization should not result in you getting a larger bill. I’m glad you are appealing the decision.

  3. Many hospitals have a “charity” clause – if you cite financial hardship, you may be able to have a portion waived, and perhaps enter a payment plan to defer the payment very, very slowly.

    • That’s good to know. I still feel a legitimate ER visit should be covered by insurance and a patient shouldn’t be burdened with a payment plan.

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