Emergency services are not everything after an emergency. They are stabilization - not full treatment. Once you were stabilized, it's no longer emergency services being provided. If there was truly no ability to go in network for the rest of the care, you would've needed to get approval and guidance in advance from the insurance.
I find it very difficult to believe that all 4-5 in network hospitals were all on diversion and not accepting new inpatients at the same time. Something like that, no matter how big the city, would only happen from a massive trauma event or some similarly major problem that would've made the news nationwide. But let's say that did happen, you still would've needed to get a special exception to use the out of network hospital for anything beyond stabilization.
This isn't even a United Healthcare thing. It's any plan, from any insurer, including Medicare and Medicaid if you end up in an ER that doesn't take Medicare/Medicaid (as many don't). They have to stabilize you, and the insurance has to pay for that stabilization. But they don't have to do anything further, nor does insurance have to pay for anything beyond stabilization if your plan doesn't include out of network coverage.
So what I understand is I should have declined the admission? I asked the doctors multiple times can I decline the admission and they said no because my condition was not stabilized…they know it’s an infection due to my labs but they don’t know what is causing the infection or pain. This is my first time in the ER and all this is new to me 😩
I will ask to be discharged tomorrow or transfer if possible then.
Unfortunately the No Surprises Act (federally at least) only applies to care you got in the ER. Once they decided to fully admit you, that no longer applies to care since it's outside of the ER then. But it means that the ER care is going to have to be covered at in network rates and the hospital either has to negotiate with the insurance for anything extra, or write it off and not charge you for it.
The sooner you can get transferred the better. Alternatively, try and get ahold of your plan and explain the situation - see if you can get written documentation from the doctors there saying that they tried to get in network hospitals to take you and were refused - and see what the plan says.
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u/Berchanhimez 11d ago
Emergency services are not everything after an emergency. They are stabilization - not full treatment. Once you were stabilized, it's no longer emergency services being provided. If there was truly no ability to go in network for the rest of the care, you would've needed to get approval and guidance in advance from the insurance.
I find it very difficult to believe that all 4-5 in network hospitals were all on diversion and not accepting new inpatients at the same time. Something like that, no matter how big the city, would only happen from a massive trauma event or some similarly major problem that would've made the news nationwide. But let's say that did happen, you still would've needed to get a special exception to use the out of network hospital for anything beyond stabilization.
This isn't even a United Healthcare thing. It's any plan, from any insurer, including Medicare and Medicaid if you end up in an ER that doesn't take Medicare/Medicaid (as many don't). They have to stabilize you, and the insurance has to pay for that stabilization. But they don't have to do anything further, nor does insurance have to pay for anything beyond stabilization if your plan doesn't include out of network coverage.