Large claim denied for treatment of child’s head injury

My five-year-old son slipped and fell in his TK classroom and got a serious concussion. I took him straight to urgent care. At urgent care, he was super out of it during the exam and the doctor asked me if she could call him an ambulance, and I said yes.

They took him to the closest hospital with a pediatric trauma unit. As they took him to get a CT he puked his guts out. The CT was clear so he just had a serious concussion, no brain bleed, as far as they could see. He puked again about 20 minutes later and then was given anti-nausea meds. Then he slept for an hour or so.

The pediatric trauma team determined that due to the severity of his symptoms, he should be admitted and monitored overnight. I was told verbally by a nurse that the night’s stay had been, ‘pre-approved.’ I did not get anything in writing on this. I spent the night with him in the pediatric ICU while he was hooked up to monitors. He was released in the morning.

The hospital submitted the claim in July (this happened in May) and my healthcare provider, Anthem PPO in California, denied the entire bill of over $16,000. I have yet to get any bill from the hospital nor can I find anything online. It’s a hospital within the UCLA hospital system. I tried to call the hospital. It took over 30 minutes just to get someone on the phone, and they said there was no direct way to speak to billing but they’d call me back in a week to see if it had been pre-approved and whether they were appealing, etc. I have not heard back yet.

Per Anthem, the claim was denied as the hospital submitted it as ‘inpatient’ not ’emergency’ and the UM did not review it and pre-approve, and therefore it was deemed medically unnecessary. I explained everything I’ve written here and they told me to appeal as it should be submitted under emergency care. These are the ICD 10 codes used per Anthem:

S060XAA, S0990XA, R1110, R402412, Y998

I’m preparing to appeal but looking for any additional advice. Should I wait to get more information from the hospital or is that unnecessary?

Thank you for any advice.