Autumn Daniels has experienced migraine headaches since childhood, but the attack that struck the 32 year old in April was worse than usual. After a week of piercing pain, she visited an urgent care center near her home in Champaign, Illinois.

The clinic gave Daniels an injection of Toradol, a nonsteroidal anti inflammatory drug that usually eases her symptoms. A doctor told her to visit an emergency room the next day if the pain failed to improve.

When the migraine persisted, Daniels’ sister drove her to the emergency room at Carle Foundation Hospital in Urbana. Daniels said the department did not appear very busy when she registered at the front desk and was briefly taken into an exam room.

A staff member checked her vital signs and asked whether she frequently had migraines, then directed her to the waiting room. Daniels said she was vomiting every 10 minutes by then, which is not uncommon during one of her severe migraine attacks.

After four hours without any indication that she would soon receive treatment, Daniels and her sister left for another hospital. She waited about an hour and a half there before receiving care that included more Toradol and medication for nausea.

Because she left Carle without receiving treatment or seeing a doctor, Daniels did not expect a bill. She said the only services provided were checks of her pulse, temperature, and blood pressure, while staff declined her sister’s request for an ice pack.

“ER triage is driven by risk of death or serious harm, not by level of suffering,” said Jennifer Robblee, a neurologist at the Barrow Neurological Institute in Phoenix and a board member at the Association of Migraine Disorders. “Migraine patients without red flags are unlikely to be prioritized, as they are not at immediate risk of dying.”

Carle nevertheless charged Daniels $410 for an “Emergency Room Level 1” visit. Her employment based health plan paid for treatment at the second hospital but denied Carle’s claim, leaving Daniels responsible for the charge.

“Under the terms of her health plan, claims associated with a patient leaving the facility against medical advice are not eligible for coverage,” Leslie Porras, a spokesperson for HealthLink, which administers Daniels’ plan, said in a statement. HealthLink said Daniels can appeal through its established process.

A Carle representative told Daniels that, effective March 1, 2026, emergency department visits could generate charges even when a patient is not seen directly by a provider. The email said care can include registration and nursing assessment, as well as diagnostic testing and treatment.

Carle said patients who leave without seeing a provider may still face charges because the hospital maintains staff, space, and equipment. The health system declined to discuss Daniels’ care or bill with KFF Health News despite her signed privacy waiver.

Carle Health spokesperson Brittany Simon said the emergency department has consistent billing practices for triage care and supports transparency in its billing processes. The hospital later told Daniels that “the charges have been determined to be accurate and fully supported by the medical record documentation.”

The bill listed one $410 charge described as “Emergency Room Level 1,” along with current procedural terminology code 99281. CPT codes cover evaluation and management services provided by medical professionals, and Level 1 is the lowest emergency care level.

The American Medical Association’s CPT guide, however, states: “Triage alone is not an E/M service; therefore, it cannot be reported with an E/M code.” AMA spokesperson Robert Mills said a physician charge under that code would generally be significantly less than $410 and suggested the hospital likely combined it with a facility fee.

Daniels said she requested an itemized bill explaining the charge but never received one. Amber Padron, assistant director of case management at the Patient Advocate Foundation, said emergency room bills typically list physician and hospital charges separately.

Daniels had visited the same emergency room in 2025 for gastrointestinal problems and left after waiting several hours. Her mother confirmed with the front desk that she would not be charged, and no bill followed, leaving Daniels unaware that Carle’s policy had changed by April.

A similar complaint reached KFF Health News in 2023 after Maggi Wettstein took her toddler to another Carle Health hospital. They left before treatment but received a $445 bill for a nasal swab test for covid and influenza.

Daniels has paid $25 toward the $410 balance and applied for financial assistance. She is considering appealing the insurance denial but remains outraged, asking, “How is it ethical or even legal for a hospital to essentially bill for occupying a waiting room?”

Patients who leave before receiving care can ask the hospital about its billing policy and contact their insurer about coverage. Padron also recommends requesting medical records, reviewing explanations of benefits, and appealing denied claims: “It’s always going to be a no if you don’t appeal.”