Can an out-of-network hospital visit be treated as in-network during an emergency?
So a few months back I visited a local county hospital that wasn’t covered by my insurance Anthem Gold PPO 30/750/20% (California). I was already skinny yet I was experiencing substantial weightloss in a short period of time. I felt extremely tired despite sleeping all day. One of the nurses measured my blood glucose and the glucometer read 814mg. The nurse informed me that it was well past the point of slipping into a coma. The doctors that subsequently screened me suspected undiagnosed type 1 diabetes and rushed me to urgent care to resolve my diabetic ketoacidosis (DKA). Basically my blood was turning acidic which corrodes arteries and damage nerves. This was also causing my kidneys to fail. It took 4 days to stabilize me until I was discharged with instructions on how to administer insulin. I was actually supposed to stay for 3 days but the doctor that was overseeing my progress called my insurance company and requested I stay 1 more day to recover safely.
Fast forward to now I received a notification that my claim was approved. I was charged $31,380 by the hospital and my insurance was only covering $5,715.60. That leaves me with an out of pocket cost of $25,664.40! I used the textchat feature on the Anthem site to get some inquiries. One of the attendees suggested I file an appeal. She said I arrived as an “inpatient” so she didn’t know how to evaluate my situation. I’ve read on other posts that insurance companies have to classify life-threatening situations as in-network even if the hospital is out-of-network. My in-network maximum out of pocket is $8,200. Is it even worth the effort appealing? Does my case count as an emergency? My EOB for the claim is still pending. I’m at a loss and don’t know how to navigate this nightmare.