First Emergency Room Visit Since Childhood

Good evening. I am looking for a little guidance. I asked already in the regular insurance sub but was advised to ask here instead. I'll lay it out in some detail, but the question boils down to how likely am I to have a problem and what should I do to get ahead of any issues.

I am 54, retired military, on Tricare Prime (which is Humana).

I had flank pain (kidney area) extending to my pelvic region (testicles) with cold sweats and vomiting. So this seemed like an emergency to me. Probably without the vomiting and sweats I would have tried to tough it out til morning but I was under the impression these symptoms suggested possible shock and/or infection.

I did a quick check that the nearest hospital "accepts" Humana and Tricare, but I know this doesn't mean they are "in-network." However, I don't even know if "in-network" applies to ERs, because the Humana/Tricare site has a list of providers by specialty, but for ER it says to go to the nearest one. I don't think it has in-network ERs unless I'm missing it.

So…I went to the nearest one. They did an ultrasound and CAT scan. Found kidney stone, ruled out testicular torsion, but found an epididymal cyst and inflammation. Sent me home with pain killers, antibiotics, and a referral to a specialist.

So, it looks like they want to charge about $30K (this is from an itemized estimate, not a bill). I'm wondering is this visit likely to be approved/denied as emergency care. With that question in mind, is there anything I should be doing now to help this decision go in my favor?

Then, even if it's approved, am I likely to see a bill for residual amounts?

Thanks!

Martine

submitted by /u/Martine_Guerre
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