How Is A Patient To Get ER Pre-Authorization?

Hi, I know there are other posts about this general subject, but not this particular issue.

I am currently in the hospital, and have been here for 3 days. I have some kind of infection, which has been stumping the doctors.

I received a notice on my health insurance app, that my Pre-Authorization claim had been denied. There isn’t much info, but the headline says “Room and Board Ward General Classification”. My guess is that the hospital put it through as a hospital admission, but my insurance, for now at least, is pushing for an ER observation admission. That is pure speculation on my part though.

My question is if I should be worried that this could result in a surprise bill. The hospital is in-network, and so far the denied claim doesn’t say anything about not being medically necessary, but I’m worried that is coming. I would think a hospital keeping me for 3 days, and from how things stand now, at least a 4th day, while they try to figure out the source/cause of my mystery infection, would be cause enough to prove that this is medically necessary.

Should I bring this up to the hospital while I am here? I feel like that could be weird, as I am asking them to dig deep to find what is wrong with me, so I don’t want to start talking money before that is settled. I just don’t know if this is a hospital vs insurance fight, or if they pass the problem onto me.

Unless I am a dunce, reading through the surprise bill medical law, I am not getting the direct answer that I want. The headline in the law made it seem that even if the insurance says I should have stayed home and figured this mystery illness out on my own, that I would only be responsible for the copay of the plan. Whether that is an ER visit copay or hospital admission copay. But I can’t find that clearly written out in the law. My plan is very clear in the benefit plan, that the ER is only covered if deemed medically necessary, which is a bit ambiguous for my liking.

Is there anything in the no surprise bill law that has the direct answer I am searching for here? Thank you

I am in NY.

submitted by /u/Dontyouhatepants0
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