Autumn Daniels is no stranger to migraine headaches, which have troubled her since childhood.<\/p>\n
The migraine tormenting the 32-year-old in April was even worse than usual. After a week of piercing head pain, she went to an urgent care center near her home in Champaign, Illinois, and received an injection of Toradol<\/a>, a non-steroidal anti-inflammatory drug that usually helps with her symptoms. The doctor at the clinic told her that if the pain didn\u2019t improve, she should go to an emergency room the next day.<\/p>\n It didn\u2019t improve. So the next morning, Daniels\u2019 sister took her to a nearby ER, at Carle Foundation Hospital in Urbana. She said the ER didn\u2019t seem very busy when she registered at the front desk and was taken briefly to an exam room, where a staffer checked her vital signs and asked whether she had migraines frequently. Then they told her to sit in the waiting room until she was called.<\/p>\n She and her sister waited. And waited. By then, Daniels said, she was vomiting every 10 minutes, a not-uncommon occurrence<\/a> during one of her serious migraine attacks.<\/p>\n After four hours, with no indication that Daniels would be seen anytime soon, her sister took her to another hospital. There, after a wait of about an hour and a half, Daniels was seen and received treatment, including more Toradol and anti-nausea medication.<\/p>\n Having left Carle without getting treatment, Daniels didn\u2019t expect to be charged.<\/p>\n Then the bill came.<\/p>\n The Medical Service<\/strong><\/p>\n Daniels said a staffer checked her pulse, temperature, and blood pressure when she arrived at Carle. She said she received no other services, nor was she seen by a doctor.<\/p>\n At one point while they sat in the waiting room, Daniels said, her sister asked for an ice pack for her head, but the staff wouldn\u2019t provide one.<\/p>\n \u201cER triage is driven by risk of death or serious harm, not by level of suffering,\u201d said Jennifer Robblee, a neurologist at the Barrow Neurological Institute in Phoenix and a board member at the Association of Migraine Disorders. \u201cMigraine patients without red flags are unlikely to be prioritized, as they are not at immediate risk of dying.\u201d<\/p>\n The Bill<\/strong><\/p>\n $410<\/strong> for an \u201cEmergency Room Level 1\u201d visit. Daniels said she requested an itemized bill showing how the hospital arrived at that figure but never received one.<\/p>\n This is not the first time<\/a> that a patient has complained to KFF Health News\u2019 \u201cBill of the Month<\/a>\u201d about receiving a bill after leaving a Carle Health emergency room without being treated. In 2023, Maggi Wettstein took her toddler to a different Carle Health hospital and was billed $445 for a nasal swab test for covid and influenza. They, too, left before getting treatment.<\/p>\n The Billing Problem: What Counts as Care?<\/strong><\/p>\n Though Daniels left the emergency room after a four-hour wait without being treated, the hospital billed her anyway. Her health plan, provided through her job as a state employee, paid for her treatment at the second hospital but denied the Carle claim, leaving her on the hook for the charges.<\/p>\n \u201cUnder the terms of her health plan, claims associated with a patient leaving the facility against medical advice are not eligible for coverage,\u201d Leslie Porras, a spokesperson for HealthLink, which administers Daniels\u2019 plan, said in a statement.<\/p>\n When Daniels asked about her bill, a Carle representative responded in an email that said: \u201cEffective March 1, 2026, Emergency Department visits may result in charges even if you are not seen directly by a provider. When you arrive at the Emergency Department, your visit begins as soon as care is initiated.\u201d<\/p>\n The email said \u201ccare\u201d could mean registration and nursing assessment, in addition to diagnostic testing and treatment. It said that even if patients leave without being seen by a provider, they may still be charged, because the hospital is using resources to maintain its staff, space, and equipment.<\/p>\n Carle Health declined to discuss Daniels\u2019 bill or her care with KFF Health News, even though Daniels signed a privacy waiver that authorized it to do so.<\/p>\n Daniels was not expecting to be charged after leaving an emergency room without receiving treatment. But a health system representative later told her an ER visit begins \u201cas soon as care is initiated,\u201d which could mean when the patient registers at the front desk and is assessed for triage purposes. (Taylor Glascock for KFF Health News)<\/p>\n In a statement, Carle Health spokesperson Brittany Simon said, \u201cOur Emergency Department has consistent billing practices for triage care,\u201d referring to the process through which patients are evaluated to ensure the most critical cases are treated first.<\/p>\n \u201cCarle Health takes patient concerns seriously and supports transparency in our billing processes,\u201d she said.<\/p>\n Typically, an ER bill would include separate dollar amounts for physician charges and hospital charges, said Amber Padron, assistant director of case management at the Patient Advocate Foundation, a nonprofit that assists patients with chronic or life-threatening conditions.<\/p>\n Daniels\u2019 bill listed a single charge, for $410. Under the description, it said \u201cEmergency Room Level 1\u201d and included the current procedural terminology code \u201c99281.\u201d CPT codes<\/a> are used to bill for evaluation and management, or E\/M, services provided by a medical professional. Level 1<\/a> is the lowest level of emergency care.<\/p>\n But there\u2019s a catch: According to the American Medical Association\u2019s CPT guide, \u201cTriage alone is not an E\/M service; therefore, it cannot be reported with an E\/M code.\u201d<\/p>\n It gets murkier. According to Robert Mills, a spokesperson for the AMA, the physician charge for an emergency visit under that CPT code would generally be significantly less than $410.<\/p>\n \u201cIt is likely the hospital consolidated the provider-billed charge with a facility fee,\u201d Mills said, referring to a fee that hospitals tack onto bills to cover their overhead costs, such as utilities.<\/p>\n Amid the billing uncertainty, Daniels is clear about one thing: The decision to charge ER patients who leave without getting treatment is recent.<\/p>\n In 2025, she went to the same emergency room with gastrointestinal problems. After waiting for several hours, she went elsewhere for care. She said that before leaving, her mother, who accompanied her that day, confirmed with the front desk that Daniels wouldn\u2019t be charged if they left then. And she wasn\u2019t.<\/p>\n \u201cSo when I went in for this visit in April, I had no idea I was going to be charged, because it was a very similar set of circumstances,\u201d Daniels said.<\/p>\n The health system didn\u2019t respond to a question about why it changed its policy.<\/p>\n The Resolution<\/strong><\/p>\n Carle didn\u2019t budge. According to the health system\u2019s email to Daniels, \u201cthe charges have been determined to be accurate and fully supported by the medical record documentation.\u201d<\/p>\n Daniels said she paid $25 of the $410 bill and has applied for financial assistance.<\/p>\n Meanwhile, according to HealthLink\u2019s statement to KFF Health News, Daniels can contest her health plan\u2019s denial: \u201cMs. Daniels has the right to appeal the decision through the established appeals process.\u201d<\/p>\n She\u2019s considering it, but she remains outraged about what happened.<\/p>\n \u201cHow is it ethical or even legal for a hospital to essentially bill for occupying a waiting room?\u201d she asked.<\/p>\n Daniels is considering contesting her health plan\u2019s denial of coverage for the ER bill: \u201cHow is it ethical or even legal for a hospital to essentially bill for occupying a waiting room?\u201d (Taylor Glascock for KFF Health News)<\/p>\n The Takeaway<\/strong><\/p>\n Don\u2019t assume you won\u2019t be billed if you leave a hospital before receiving medical care. You can check with the front desk about the facility\u2019s policy, as well as ask your insurer whether it provides coverage for such bills.<\/p>\n If the hospital billing department isn\u2019t giving you information about what services you\u2019re being billed for, request your medical records, said Padron, of the Patient Advocate Foundation.<\/p>\n Furthermore, when your health plan processes a claim, you should receive an explanation of benefits informing you of that and explaining what you may owe. Keep an eye on your mail and your insurance portal.<\/p>\n When a claim is denied, filing an appeal with your health plan is always a smart idea, Padron said.<\/p>\n \u201cIt\u2019s always going to be a no if you don\u2019t appeal,\u201d she said.<\/p>\n Bill of the Month is a crowdsourced investigation by KFF Health News<\/a> and The Washington Post\u2019s Well+Being<\/a> that dissects and explains medical bills.\u00a0Since 2018, this series has helped many patients and readers get their medical bills reduced, and it has been cited in statehouses, at the U.S. Capitol, and at the White House. Do you have a confusing or outrageous medical bill you want to share? Tell us about it<\/a>!<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" Autumn Daniels is no stranger to migraine headaches, which have troubled her since childhood. The migraine tormenting the 32-year-old in April was even worse than usual. After a week of piercing head pain, she went to an urgent care center near her home in Champaign, Illinois, and received an injection of Toradol, a non-steroidal anti-inflammatory…<\/p>\n","protected":false},"author":0,"featured_media":15779,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-15778","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15778"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15778"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/15778\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/media\/15779"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15778"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15778"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15778"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}