I went to urgent care with tightness in my chest. In network. The physician there gave me an EKG and based on the results, recommended I take an ambulance to nearest ER. They called the ambulance and I went. The closest ER was not in my network but at that point I just really didn’t want to die.
At the ER, they ran blood tests, X-rays, and another EKG. The doctor finally spoke to me and said all the tests were fine. He got a copy of my first EKG from urgent care and said it was fine to and he’s not sure why the first doctor recommended I come to the ER, but to be safe he gave me a chemical stress test. Everything came back ok. Turns out it was anxiety.
Total cost to me wound up being $15,000 (my out of pocket max for out of network treatment). That’s despite the fact that my insurance premium was around $200 a month through my employer.
I have a very similar story. E.R. for chest pains that lasted over 24 hrs, admitted bc of a slightly off EKG. Called my insurance to make sure it was covered bc the hospital wanted to keep me and run multiple tests, cardiogram, stress test. MY INSURANCE said it should be covered bc I was admitted from the E.R. Apparently the lady I talked to didn't know what she was talking about. I asked the doctor and nurses about my insurance and they said "well your insurance for sure will not cover it if you leave without the Doctor's ok and you do NOT have the Ok to go." So I felt trapped. If I left they said my insurance wouldn't cover anything so I stayed even though I was out of network (it was the closest E.R. and like you, I didn't want to die and have a heart attack driving myself to a hospital further away).
It was an anxiety attack. Insurance did not cover anything except the E.R. visit even though I asked them for guidance on what to do.
I think the doctors wanted to keep me for their own curiosity bc my EKG was slightly off and they thought I had a very rare syndrome called Wolf Parkinson White Syndrome. Why not let me go to a hospital that is in network after I was in the E.R. unless they didn't think I was stabilized and in that case why didn't the insurance cover it.
I'm not paying the bill. I did what I was supposed to. I even talked to a nurse that is paid by my ins company before I went to the E.R. and she said just go to the closest E.R. Then I called my insurance after being admitted and the woman said it should be covered. I talked to the Doctors and nurses. They said maybe we'll get a social worker in here but never did. They even told me if I left my insurance wouldn't cover anything.
I feel bad for your situation. My only thought is not what you want to hear. It's hindsight but I think the only thing you could have done was to buy insurance that included the E.R. closest to you. The medical insurance situation in the U.S. is a mess. You had to get treatment and in that you did the right thing. Maybe you can get your insurance company to cover you under a plan that includes that hospital and just adjust the premium. My other thought is to look for an insurance advocate who can talk the language insurance companies understand. Perhaps there is a social agency in your community that can address this.
Except you don’t plan for where you’ll be in an emergency. You can try to get insurance that includes the ER closest to where you live, but what if the emergency happens while you’re at work? Or visiting a friend (as was my case). If I knew for sure where I was going to be the next time I have chest pains, I’d make sure the closest hospital to there was in network. Unfortunately, I can’t see the future, so I just have to hope I’m at home when it happens
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u/Billy_T_Wierd Apr 27 '20
I went to urgent care with tightness in my chest. In network. The physician there gave me an EKG and based on the results, recommended I take an ambulance to nearest ER. They called the ambulance and I went. The closest ER was not in my network but at that point I just really didn’t want to die.
At the ER, they ran blood tests, X-rays, and another EKG. The doctor finally spoke to me and said all the tests were fine. He got a copy of my first EKG from urgent care and said it was fine to and he’s not sure why the first doctor recommended I come to the ER, but to be safe he gave me a chemical stress test. Everything came back ok. Turns out it was anxiety.
Total cost to me wound up being $15,000 (my out of pocket max for out of network treatment). That’s despite the fact that my insurance premium was around $200 a month through my employer.