Autumn Daniels, a 32-year-old from Champaign, Illinois, is no stranger to migraine headaches. In April, she experienced a severe migraine that didn’t improve after a week of piercing head pain and a visit to an urgent care center. The doctor at the clinic advised her to go to an emergency room if the pain didn’t subside.
Daniels’ sister took her to the Carle Foundation Hospital in Urbana, where she waited for four hours without being seen by a doctor. During this time, she vomited every 10 minutes due to the severity of her migraine. Eventually, her sister took her to another hospital, where she received treatment, including more Toradol and anti-nausea medication.
Despite leaving the Carle Foundation Hospital without receiving treatment, Daniels was billed $410 for an “Emergency Room Level 1” visit. She requested an itemized bill but never received one. According to Jennifer Robblee, a neurologist at the Barrow Neurological Institute, “ER triage is driven by risk of death or serious harm, not by level of suffering.”
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Billing Practices
Daniels’ health plan, provided through her job as a state employee, paid for her treatment at the second hospital but denied the Carle claim, leaving her responsible for the charges. A Carle representative explained 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.
Carle Health declined to discuss Daniels’ bill or her care, despite her signing a privacy waiver. The hospital spokesperson, Brittany Simon, stated that the Emergency Department has consistent billing practices for triage care and that the hospital takes patient concerns seriously and supports transparency in its billing processes.
Daniels’ bill listed a single charge of $410, with the description “Emergency Room Level 1” and the current procedural terminology code “99281.” According to the American Medical Association’s CPT guide, “Triage alone is not an E/M service; therefore, it cannot be reported with an E/M code.”
Amber Padron, assistant director of case management at the Patient Advocate Foundation, noted that typically, an ER bill would include separate dollar amounts for physician charges and hospital charges. Daniels’ bill, however, listed only a single charge.
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Daniels is considering appealing her health plan’s denial of the Carle claim. She has already paid $25 of the $410 bill and has applied for financial assistance. The decision to charge ER patients who leave without getting treatment is a recent development, and Daniels is outraged about being billed. As she deals with this situation, Daniels is left to consider how it is ethical or legal for a hospital to bill patients in such circumstances.
Leslie Porras, a spokesperson for HealthLink, stated that claims associated with a patient leaving the facility against medical advice are not eligible for coverage under the terms of Daniels’ health plan. According to HealthLink’s statement, Daniels can contest her health plan’s denial through the established appeals process.
Seeking Transparency
The hospital’s decision to charge patients who leave without receiving treatment is a change from its previous policy, as evidenced by Daniels’ experience in 2025 when she was not charged after leaving the emergency room without being treated. At that time, the hospital did not bill her for the visit.
