Hospital insurance - accidental ER admission
April 23, 2019 6:58 PM Subscribe
I have a young baby. The pediatrician told us to head to the hospital for a jaundice blood test. They said they put in the order and to go to the "main entrance" and get directions. Before I realized what I'd done, I got us admitted in the pediatric ER and am now freaking out about getting billed $2k for an ER visit when I was supposed to get a simple blood test.
The good thing, I guess, is that we have a high-deductible plan without copays and will already have hit the max this year. But will insurance know I screwed up and refuse to cover this? Should I worry about this "balance billing" I hear about?
Is there anything I can do? The hospital staff said "no you can't get un-admitted" as though that was the world's dumbest question. I mean they'd already taken baby's temp! And printed a wrist band!
If baby needs the UV lights to bring down jaundice should I continue to accept help via the hospital or try to sign out and get back in touch with the doctor's office (who was standing by for test results tonight)?
All advice welcome.
The good thing, I guess, is that we have a high-deductible plan without copays and will already have hit the max this year. But will insurance know I screwed up and refuse to cover this? Should I worry about this "balance billing" I hear about?
Is there anything I can do? The hospital staff said "no you can't get un-admitted" as though that was the world's dumbest question. I mean they'd already taken baby's temp! And printed a wrist band!
If baby needs the UV lights to bring down jaundice should I continue to accept help via the hospital or try to sign out and get back in touch with the doctor's office (who was standing by for test results tonight)?
All advice welcome.
You may not have actually screwed up. We went through the same thing with my youngest when she was a couple days old and they specifically had us go to the ER for bilirubin testing. My HDHP insurance covered it without a hitch and we only had to pay a small amount in coinsurance. Hoping everything goes smoothly for you and your little one!
posted by galvanized unicorn at 7:23 PM on April 23, 2019 [6 favorites]
posted by galvanized unicorn at 7:23 PM on April 23, 2019 [6 favorites]
I agree. I don't think you made a mistake. The pediatrician told you to go to the Hospital. That's where you went.
posted by mundo at 7:53 PM on April 23, 2019 [1 favorite]
posted by mundo at 7:53 PM on April 23, 2019 [1 favorite]
Best answer: If there was a lab you could have gone too, they should have let you with a simple explination. I'd file a complaint with patient relations that you once you registered you realized you were in the wrong place, tried to get it corrected and was told you couldn't. You could talk to the on duty administrator right now, but depending how long you've been there at this point it isn't worth doing.
As a medical social worker, I've run into stuff like this before, it is fixable but has to happen in the moment.
You child might have juandice, which can require hospitalization. In terms of what your insurance recieves it isn't going to look abnormal or weird. Besides, this way you'll get the results before you leave.
In addition this is one of those times you can all your doctor's line if they have admitting privileges to get them to tell the staff to let you do what you were actually there to do.
posted by AlexiaSky at 8:41 PM on April 23, 2019 [5 favorites]
As a medical social worker, I've run into stuff like this before, it is fixable but has to happen in the moment.
You child might have juandice, which can require hospitalization. In terms of what your insurance recieves it isn't going to look abnormal or weird. Besides, this way you'll get the results before you leave.
In addition this is one of those times you can all your doctor's line if they have admitting privileges to get them to tell the staff to let you do what you were actually there to do.
posted by AlexiaSky at 8:41 PM on April 23, 2019 [5 favorites]
Response by poster: Thanks for all the answers. Turns out the jaundice is high enough that my pediatrician would've sent us to get admitted. So, I'm assuming the insurance will have to cover it now. We just ended up here early.
posted by slidell at 8:45 PM on April 23, 2019 [19 favorites]
posted by slidell at 8:45 PM on April 23, 2019 [19 favorites]
Best answer: Are you in the ER right now? Please don’t worry about billing until you get lab results back. I took my baby in for a 3 day well baby visit and got admitted to the hospital for jaundice while we were in the clinic - it came as a total shock (I certainly didn’t pack anything for an overnight stay!). Things may move quickly, and you may end up on the pediatric floor shortly. Sending you strength and calm vibes.
posted by Maarika at 8:46 PM on April 23, 2019 [2 favorites]
posted by Maarika at 8:46 PM on April 23, 2019 [2 favorites]
Best answer: Just saw your update - best wishes to you. My baby never looked so relaxed as he did under the lights of the “baby spa.” I hope you are able to get some rest and are comfortable in the hospital room tonight.
posted by Maarika at 8:49 PM on April 23, 2019 [9 favorites]
posted by Maarika at 8:49 PM on April 23, 2019 [9 favorites]
Best answer: Just as a note, it is worth talking to patient relations about this, not for billing but because the biggest role of registration staff is active listening to understand what you need to start your process. They communicate the initial complaint and triage that gets you ready to be seen. If you needed the lab, AND you got the ER that is a failure point. If that's just how they do things, then obviously it went as planned. And it isn't your fault if you didn't know the words or location, these staff should be trained in working and communicating with people with all sorts of levels of health literacy, and people who are sick and tired and not thinking clearly for a variety of reasons.
These errors don't get caught often because people don't bother to complain. Obviously, your a new mom and have tons to worry about, so if you can't you can't, that's 100% OK. These are things I'm very very interested in because I end up with these cases every once in awhile and they really don't have to happen, and the response after you figured it out could have been better or atleast more reassuring to you.
posted by AlexiaSky at 4:37 AM on April 24, 2019 [7 favorites]
These errors don't get caught often because people don't bother to complain. Obviously, your a new mom and have tons to worry about, so if you can't you can't, that's 100% OK. These are things I'm very very interested in because I end up with these cases every once in awhile and they really don't have to happen, and the response after you figured it out could have been better or atleast more reassuring to you.
posted by AlexiaSky at 4:37 AM on April 24, 2019 [7 favorites]
Best answer: Please do talk to patient relations about this ... in addition to what AlexiaSky said above, there could be a failure in the electronic health record process here. If your doc put in an order for lab work (non-emergency) through an electronic system, it should have been interpreted on the hospital end to indicate "regular lab" as opposed to ED. In theory, the person in the ED who opened your record should have been able to tell that you were not meant to be there and should have redirected you to the regular lab.
This could be not applicable depending on how their systems work, but if it *is* a problem they'll be wanting to get it fixed.
posted by mccxxiii at 5:43 AM on April 24, 2019 [1 favorite]
This could be not applicable depending on how their systems work, but if it *is* a problem they'll be wanting to get it fixed.
posted by mccxxiii at 5:43 AM on April 24, 2019 [1 favorite]
Best answer: In addition to the good advice above, I would ask the pediatrician at your next appointment whether they intended for you to go to the hospital lab or to the ER. Sometimes patients are sent to the ER for the explicit purpose of drawing blood work because the results come back much quicker than if you were sent to the lab. They should have communicated where you should go more clearly and I’m sorry you had that added stress. The pediatrician surely sends patients to get bilirubin levels drawn regularly, and he or she should know that the way they are directing families right now is not clear enough.
posted by amy.g.dala at 6:25 AM on April 24, 2019 [2 favorites]
posted by amy.g.dala at 6:25 AM on April 24, 2019 [2 favorites]
I think it all worked out for the best! We had to do a stat bilirubin test for our baby at 4 days old (the day after discharge) after the pediatrician saw how much weight he had lost and his borderline high bilirubin levels at the hospital. [BOOO overzealous breastfeeding promotion, but I digress ... ] There was a lab above the pediatrician's office, so we just took him there for the test, and the doctor said she would call us with the results. As it turned out, the results were normal ... but the doctor's message didn't get through to us, because in my sleep-deprived haze I didn't realize my voicemail was full. Neonatal jaundice can be a real emergency, so it's much better to be in one place where they can do the test, get you the result, and start treatment ASAP.
posted by schwinggg! at 11:35 AM on April 24, 2019 [1 favorite]
posted by schwinggg! at 11:35 AM on April 24, 2019 [1 favorite]
In theory, the person in the ED who opened your record should have been able to tell that you were not meant to be there and should have redirected you to the regular lab.
Question: is it even possible to get admitted to the hospital on accident? Every time I've been to the ER, it's the doctor who decides whether to actually admit you, after an often lengthy observation/treatment process. It sounds like OP's real issue is that she went to the ER for the test, as opposed to the lab? Not the hospital admission? You can get a test in the ER without getting admitted to the hospital ...
posted by schwinggg! at 11:39 AM on April 24, 2019
Question: is it even possible to get admitted to the hospital on accident? Every time I've been to the ER, it's the doctor who decides whether to actually admit you, after an often lengthy observation/treatment process. It sounds like OP's real issue is that she went to the ER for the test, as opposed to the lab? Not the hospital admission? You can get a test in the ER without getting admitted to the hospital ...
posted by schwinggg! at 11:39 AM on April 24, 2019
Response by poster: Now that I'm finally out of the ER and on the pediatric floor (as of 1 am, after 7 hours) I will point anyone with anything similar going on in their life to this recommendation from an AAP Publication:
RECOMMENDATION 7.1.2: If the TSB is at a level at which exchange transfusion is recommended (Fig 4) or if the TSB level is 25 mg/dL (428 μmol/L) or higher at any time, it is a medical emergency and [editorial addition: in those cases and also for any families who prefer not to sit around doing nothing about potentially serious medical conditions] the infant should be admitted immediately and directly to a hospital pediatric service for intensive phototherapy. These infants should not be referred to the emergency department, because it delays the initiation of treatment 54. [emphasis added]
Whether or not the billi levels are in the "yellow" or the "red" zone, see if you can get admitted directly to the pediatric floor because the ER may do very little for you except keep you stuck in an uncomfortable room without easy access to snacks and water. This pediatric floor had no space, but had I not been already admitted, if we'd pursued that approach to getting treatment (gotten tested independently, then asked if the pediatrician could get us admitted directly to a pediatric floor instead of walking into an ER) I could have driven to one of the other area hospitals that already had an open spot. Maybe things don't normally work that way, though, I don't really know.
posted by slidell at 12:24 PM on April 24, 2019
RECOMMENDATION 7.1.2: If the TSB is at a level at which exchange transfusion is recommended (Fig 4) or if the TSB level is 25 mg/dL (428 μmol/L) or higher at any time, it is a medical emergency and [editorial addition: in those cases and also for any families who prefer not to sit around doing nothing about potentially serious medical conditions] the infant should be admitted immediately and directly to a hospital pediatric service for intensive phototherapy. These infants should not be referred to the emergency department, because it delays the initiation of treatment 54. [emphasis added]
Whether or not the billi levels are in the "yellow" or the "red" zone, see if you can get admitted directly to the pediatric floor because the ER may do very little for you except keep you stuck in an uncomfortable room without easy access to snacks and water. This pediatric floor had no space, but had I not been already admitted, if we'd pursued that approach to getting treatment (gotten tested independently, then asked if the pediatrician could get us admitted directly to a pediatric floor instead of walking into an ER) I could have driven to one of the other area hospitals that already had an open spot. Maybe things don't normally work that way, though, I don't really know.
posted by slidell at 12:24 PM on April 24, 2019
This is a little left field but since we're information sharing - my son avoided an exchange transfusion by 7 minutes (his billirubin came down just in time.) The reason he did was his results came back while I was downstairs coordinating getting my bag, and when I came up in the elevator the NICU team was on hand and stripped his clothes off marching down the hall and threw him, naked, into the triple-light set-up...without talking to me except to say they would talk to me soon.
We'd come in for lactation consult, but he was nursing fine, it was a specific issue.
Jaundice can be an emergency requiring immediate care. It's also a cause of cerebral palsy. I'm so glad you're in the right place! BTW my son is 8 and has great hearing and is in really good shape. :)
posted by warriorqueen at 2:15 PM on April 24, 2019
We'd come in for lactation consult, but he was nursing fine, it was a specific issue.
Jaundice can be an emergency requiring immediate care. It's also a cause of cerebral palsy. I'm so glad you're in the right place! BTW my son is 8 and has great hearing and is in really good shape. :)
posted by warriorqueen at 2:15 PM on April 24, 2019
Response by poster: We're out of the hospital now and home safe. Thanks again for all of the support and information!
posted by slidell at 1:58 PM on April 25, 2019 [2 favorites]
posted by slidell at 1:58 PM on April 25, 2019 [2 favorites]
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posted by mundo at 7:19 PM on April 23, 2019