Autumn Daniels knows migraines well, having suffered from them since she was a child.
But the one that tormented Daniels, 32, in April was worse than usual. After a week with a throbbing headache, he went to an urgent care center near his home in Champaign, Illinois, where he received an injection of Toradol, a nonsteroidal anti-inflammatory drug that usually helps relieve his symptoms.
The doctor at the clinic told him that if the pain did not improve, he should go to an emergency room the next day.
It didn’t get better. So the next morning, Daniels’ sister took her to a nearby emergency room, at Carle Foundation Hospital in Urbana. Daniels said there didn’t seem to be many people when she checked in at the front desk and she was briefly taken to an exam room, where a staff member checked her vital signs and asked if she frequently suffered from migraines.
She was then told to sit in the waiting room until she was called.
He waited with his sister. And they continued waiting. By then, Daniels said, he was vomiting every 10 minutes, not unusual during one of his severe migraine attacks.
After four hours, with no indication that Daniels would be seen soon, her sister took her to another hospital. There, after waiting about an hour and a half, she was seen and received treatment, which included more Toradol and anti-nausea medication.
Since he had left Carle without receiving treatment, Daniels did not expect to be charged anything.
Then the bill arrived.
The medical service
Daniels said when he arrived at Carle, a staff member took his pulse, temperature and blood pressure. She said that she did not receive any other services nor was she treated by a doctor.
At one point, while they were sitting in the waiting room, Daniels’ sister asked for an ice pack to put on her head, but the staff refused to give it to her.
“Emergency room triage is based on the risk of death or serious harm, not the level of suffering,” said Jennifer Robblee, a neurologist at Barrow Neurological Institute in Phoenix and a board member of the Association of Migraine Disorders.
“Migraine patients who do not have warning signs are unlikely to be prioritized as they are not at immediate risk of dying.”
The invoice
$410 for a “Level 1 emergency room” visit. Daniels said he asked for an itemized bill showing how the hospital arrived at that figure, but never received it.
This is not the first time a patient has complained to ’ “Bill of the Month” about receiving a bill after leaving a Carle Health emergency room without receiving treatment. In 2023, Maggi Wettstein took her young son to another Carle Health hospital and received a $445 bill for a nasal swab test for influenza and Covid. They also left before receiving treatment.
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The Billing Problem: What Is Considered Health Care?
Although Daniels left the emergency room after waiting four hours without treatment, the hospital still charged him. Her health plan, which she receives through her employment as a state worker, paid for the treatment she received at the second hospital, but denied Carle’s claim, leaving Daniels responsible for paying that bill.
“Under the terms of his health plan, claims related to a patient leaving the facility against medical advice are not eligible for coverage,” Leslie Porras, a spokeswoman for HealthLink, which administers Daniels’ plan, said in a statement.
When Daniels asked about the bill, a Carle representative responded in an email: “Beginning March 1, 2026, visits to the Emergency Department may incur charges even if the patient is not seen directly by a provider. When you arrive at the Emergency Department, your visit begins as soon as care begins.”
The email said “care” could include nursing registration and assessment, in addition to diagnostic testing and treatment. It also noted that even if patients leave without being seen by a provider, they can be charged because the hospital uses resources to maintain its staff, facilities and equipment.
Carle Health declined to speak to about the bill or Daniels’ care, even though she signed a privacy release allowing the health system to do so.
In a statement, Carle Health spokesperson Brittany Simon said, “Our Emergency Department maintains consistent billing practices for triage care,” referring to the process by which patients are evaluated to ensure the most critical cases are seen first.
“Carle Health takes patient concerns seriously and supports transparency in our billing processes,” he said.
Typically, an emergency room bill would include separate amounts for doctor charges and hospital charges, said Amber Padron, assistant director of case management for the Patient Advocate Foundation, a nonprofit that helps patients with chronic or life-threatening conditions.
Daniels’ bill included a single charge of $410. The description said “Emergency Room, Level 1” and included the current medical procedure terminology, or CPT, code, “99281.” CPT codes are used to bill for evaluation and management services, known as E/M, provided by a medical professional. Level 1 is the lowest level of emergency care.
But there is an important detail: according to the American Medical Association (AMA) CPT code guide, “triage alone is not an E/M service; therefore, it cannot be billed using an E/M code.”
And the situation becomes even less clear. According to AMA spokesman Robert Mills, the doctor’s charge for an emergency visit under that CPT code would generally be considerably less than $410.
“The hospital likely consolidated the charge billed by the provider with a facility fee,” Mills said, referring to a charge that hospitals add to bills to cover their overhead costs, such as utilities.
Amid billing uncertainty, Daniels is clear on one thing: The decision to charge ER patients who leave without treatment is recent.
In 2025, he went to the same emergency room for gastrointestinal problems. After waiting several hours, he decided to go somewhere else to receive care. Daniels said that before she left, her mother, who was with her that day, confirmed at the front desk that she would not be charged if they left at that time. And he didn’t receive any invoice.
“So when I went for this visit in April, I had no idea I was going to be charged, because the circumstances were very similar,” Daniels said.
The health system did not respond to a question about why it had changed its policy.
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The resolution
Carle did not change his position. According to the email the health system sent to Daniels, “the charges were determined to be correct and fully supported by medical record documentation.”
Daniels said she paid $25 of the $410 bill and applied for financial assistance.
Meanwhile, according to the statement HealthLink provided to , Daniels can challenge her health plan’s decision: “Ms. Daniels has the right to appeal the decision through the established appeals process.”
She is considering doing so, but remains outraged by what happened.
“How can it be ethical or even legal for a hospital to basically charge you for a spot in a waiting room?”asked.
The conclusion
Don’t assume you won’t receive a bill if you leave a hospital before receiving medical care. You can ask at the reception what the establishment’s policy is and check with your insurer if your plan covers these types of bills.
If the hospital billing department doesn’t provide you with information about the services you’re being billed for, request your medical records, recommended Padron of the Patient Advocate Foundation.
Additionally, when your health plan processes a claim, you should receive an explanation of benefits that informs you about the process and details how much you may have to pay. Pay attention to the email and check your insurance portal.
When a claim is denied, filing an appeal with your health plan is always a good idea, Padron said.
“If you don’t appeal, the answer will always be no,” he said.
Bill of the Month is a collaborative investigation of and Well+Being from The Washington Post that analyzes and explains medical bills. Since 2018, this series has helped many patients and readers reduce their medical bills, and has been cited in state legislatures, the U.S. Capitol, and the White House. Do you have a confusing or exorbitant medical bill you want to share? Tell us your case!
