Woman billed after leaving emergency room untreated

Autumn Daniels, a 32-year-old woman, went to the emergency room at Carle Foundation Hospital in Urbana, Illinois, seeking relief from a severe migraine. After waiting for four hours, she left the hospital without receiving treatment and was later billed $410.

Daniels had been experiencing migraine headaches since childhood and had visited an urgent care center the previous day, where she received an injection of Toradol, a non-steroidal anti-inflammatory drug. However, her symptoms worsened, and she was advised to visit the emergency room if her condition didn’t improve.

Upon arrival at the emergency room, Daniels was briefly taken to an exam room, where a staffer checked her vital signs and asked about her migraine history. She was then told to wait in the waiting room until she was called. Daniels and her sister waited for four hours, during which time Daniels vomited every 10 minutes due to her severe migraine.

After four hours, Daniels’ sister took her to another hospital, where she was seen and received treatment, including more Toradol and anti-nausea medication. Daniels didn’t expect to be charged for the initial emergency room visit, as she hadn’t received any treatment.

However, she received a bill for $410, which included a charge for an “Emergency Room Level 1” visit. The bill listed a single charge, with the current procedural terminology code “99281,” which is used to bill for evaluation and management services provided by a medical professional.

Emergency Room Triage Practices

According to Jennifer Robblee, a neurologist at the Barrow Neurological Institute, emergency room triage is driven by risk of death or serious harm, not by level of suffering. This means that patients with migraines, like Daniels, may not be prioritized, as they are not at immediate risk of dying.

Daniels’ bill has raised questions about the ethics and legality of billing patients for occupying a waiting room without receiving treatment. The American Medical Association’s CPT guide states that triage alone is not an evaluation and management service; therefore, it cannot be reported with an evaluation and management code.

Robert Mills, a spokesperson for the AMA, noted that the physician charge for an emergency visit under the CPT code used in Daniels’ bill would generally be significantly less than $410. It is likely that the hospital consolidated the provider-billed charge with a facility fee, which is a fee that hospitals tack onto bills to cover their overhead costs.

Daniels has applied for financial assistance and is considering appealing her health plan’s denial of the claim. She paid $25 of the $410 bill and is outraged about the hospital’s decision to charge her for the emergency room visit.

Hospital Billing Practices Questioned

The hospital’s billing practices have been questioned before. In 2023, another patient, Maggi Wettstein, was billed $445 for a nasal swab test after leaving a Carle Health emergency room without receiving treatment.

Carle Health declined to discuss Daniels’ bill or her care, despite her signing a privacy waiver that authorized the hospital to do so. The health system’s spokesperson, Brittany Simon, stated that the hospital has consistent billing practices for triage care and takes patient concerns seriously.

Amber Padron, assistant director of case management at the Patient Advocate Foundation, advised patients to request their medical records if the hospital billing department isn’t providing information about the services they’re being billed for. She also recommended keeping an eye on mail and insurance portals for explanations of benefits.

Carle Health’s email to Daniels stated that “care” could mean registration and nursing assessment, in addition to diagnostic testing and treatment, and that patients may still be charged even if they leave without being seen by a provider. The hospital’s policy has changed since Daniels’ previous visit in 2025, when she was not charged after leaving the emergency room without receiving treatment.