When Kimberly Fister Mesch woke up with head pain so severe she thought she was having a stroke, her husband rushed her to the emergency room.
"The pain was so intense that I knew something had to be wrong," Mesch said.
To her relief, the pain wasn't from a stroke, but a serious ear infection.
Later, she got a bill for about $4,300 because her diagnosis wasn't considered a medical emergency by her insurer, Anthem. Instead, Anthem said, she should have called the company's 24/7 online doctor service, or gone to her own doctor or urgent care.
Anthem is not the only health insurance company trying to discourage costly emergency room care. companies charge a higher copay for emergency room visits compared with visits to urgent cares or walk-in clinics.
Consumer Reports, along with medical experts, say policies like Anthem's are leaving consumers with huge medical bills and could keep patients from going to the emergency room when they should.
"People don't come to us because they want to come to us," Dr. Ryan, an emergency room doctor,
said. "They come to us because they need us."
How can you make sure this won't happen to you? First, make sure you understand your insurance.
"Check your insurer's emergency service benefits coverage to see how it defines an emergency and what your plan will and won't cover," said Margot Gilman, Consumer Reports money editor.
While most insurers offer general guidelines as to what constitutes an emergency, they don't limit policyholders to specific injuries or illnesses.
If your insurer rejects a claim, you have the right to do what Mesch did: file an appeal.
Mesch sent a letter to her insurer with her medical records and filed a complaint with her state insurance regulator. Anthem ultimately reversed its decision.
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