full image - Repost: Severe Pain, ER Visit, and Insurance Worries: How Likely Is a Claim Denial? (from Reddit.com, Severe Pain, ER Visit, and Insurance Worries: How Likely Is a Claim Denial?)
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Last Wednesday, my spouse woke up in the middle of the night with vomiting and diarrhea. Later that day, she got her period, and we thought she might have caught a bug coinciding with her cycle. After a day or two, she started to feel better.Then her symptoms returned, including vomiting and being unable to keep food down. She developed severe pain on her right side near her ovaries, accompanied by cold sweats, fever, and sleeplessness. By Sunday, the pain in her uterus/ovary area was so severe she was crying and utterly exhausted, so we went to urgent care.Urgent care immediately referred her to the ER, suspecting a twisted ovary or ovarian rupture, and provided a note indicating the need for urgent evaluation. At the ER, they ran blood tests but couldn’t perform a pelvic exam due to the lack of specialists. Instead, a CT scan with contrast was ordered due to concerns about appendicitis.The results showed her ovaries and appendix were fine, though she had minor ovarian cysts that weren’t concerning. However, the scan revealed slight swelling in her right kidney, prompting a referral to a urologist. Since a pelvic exam wasn’t performed, they also advised follow-up with her OBGYN.We left the ER with pain management medication and instructions to follow up with specialists. I checked beforehand, and both urgent care and the ER are in-network. However, I’m worried insurance might deem this visit non-emergent and deny coverage. We’re $700 away from meeting our deductible, and this is her first ER visit. She typically handles pain well, but this time it was so severe she was in tears. We can’t afford to face a large bill if the claim is denied.
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