A four-hour emergency room wait is grueling under any circumstances — but for one Illinois woman suffering from a severe migraine, it became even more troubling when she was later billed despite never seeing a doctor.
Autumn Daniels spent those hours repeatedly vomiting in a hospital waiting room, only to later receive a $410 charge, KFF Health News reported.
Here's what to know
At Carle Foundation Hospital in Urbana, Daniels' emergency visit amounted to a brief intake followed by a long return to the waiting room: staff checked her pulse, temperature, and blood pressure, briefly asked about her migraine history, and then sent her back to wait.
Daniels, a 32-year-old from Champaign, had gone there after an urgent care doctor advised emergency treatment if a Toradol shot did not ease a migraine that had lasted a week.
She ultimately sought care elsewhere.
After about four hours at Carle without treatment, Daniels left, and her sister drove her to another hospital, where she said she was seen after about 90 minutes and given medication.
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Carle billed Daniels $410 for an "Emergency Room Level 1" visit. HealthLink, which administers Daniels' plan, denied her claim.
In a statement, HealthLink spokesperson Leslie Porras asserted that under Daniels' plan, "claims associated with a patient leaving the facility against medical advice are not eligible for coverage."
In an email to Daniels, Carle confirmed the policy.
"Effective March 1, 2026, Emergency Department visits may result in charges even if you are not seen directly by a provider," it read in part.
"When you arrive at the Emergency Department, your visit begins as soon as care is initiated." The health system said that can include registration and a nursing assessment.
"ER triage is driven by risk of death or serious harm, not by level of suffering," Jennifer Robblee, a Phoenix neurologist at the Barrow Neurological Institute and a board member of the Association of Migraine Disorders, told KFF Health News.
"Migraine patients without red flags are unlikely to be prioritized, as they are not at immediate risk of dying," she added.
More background
The bill Daniels received raised questions beyond the long wait.
It included a single charge under CPT code 99281, which is used for evaluation and other services at the lowest level of emergency care.
However, 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."
"It is likely the hospital consolidated the provider-billed charge with a facility fee," Robert Mills, an AMA spokesperson, told KFF Health News, suggesting the total could reflect overhead and operational costs as much as direct, hands-on treatment.
"Our Emergency Department has consistent billing practices for triage care," Carle Health spokesperson Brittany Simon admitted.
She added that the system "takes patient concerns seriously and supports transparency in our billing processes."
What can be done?
Asking the front desk about hospital billing policy before leaving may help, as can checking with an insurer to understand whether it covers charges for a visit where no provider was seen.
Amber Padron, assistant director of case management at the Patient Advocate Foundation, advised requesting medical records if a billing department will not clearly explain a charge.
Patients should also review the explanation of benefits from their insurer, which can clarify what was billed, what was denied, and what they may still owe.
If coverage is denied, an appeal may still be worth pursuing.
"It's always going to be a no if you don't appeal," Padron observed.
Where can I learn more?
These healthcare stories look at other ways patients can run into problems with care quality, emergency access, and billing. They cover hospice complaints in Washington, a medical-debt dispute in Kansas, and rising ER visits associated with hotter weather.
• In Washington, hospice staff said rushed visits and false records followed a private-equity joint venture.
• In Kansas, a hospital garnished the wages of a woman despite the fact that she appeared to qualify for free care.
• In Australia's Capital Territory, small temperature increases were linked with more emergency room visits.
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