"Hi, I'm unconscious. Would you please treat me?"

Here's how the insurance is making my Jan. 2011 Emergency Room visit appear:

"Hello, I've just arrived by ambulance. I'm unconscious. Would you please treat me?"

Here's how it really happened:
I passed out from a low blood sugar while in California. An ambulance was called. They put me on a glucose IV drip to save my life, and took me to the ER. The ER kept me around long enough to see that my blood sugars were stable again. It seems like an open-and-shut case. The problem is that one little item on the bill reads: Observation room fee. Apparently this item triggered the entire bill (with the exception of three items that contained the word "emergency" in them) to be treated as outpatient care. As if I had pre-arranged to get treatment and willingly checked myself into the hospital.

The problem was that my doctor put me in another room within the Emergency/Critical Decision Unit department, but the bill from the hospital to the insurance company does not contain any more detail than a list of the services and the amounts, such as:

Laboratory $78
Unicyclin $109
Emergency room $2151
Observation room $1051
IV start $314
Physician fee $410

The insurance company leaves it up to them, or possibly some automated system, to determine what type of visit it was. The hospital does not provide this information.

I'll just add that it took me around 10 hours of phone calls, poring through the Explanation of Benefits that CareFirst sent me, looking at the coded hospital bill to the insurance company, doctor's notes, medical records, and speaking with the billing department and medical records at the hospital, around 4 different people at CareFirst, and a lawyer specializing in insurance issues before getting to this information.

My insurance company is not only trying to kill me, but is also trying to shirk out of paying for the services outlined in my member benefits.

Under Emergency Room coverage, this visit would cost me a $35 copay. As they are trying to have it, as outpatient care, I am held accountable for $1045.