I have insurance through work – Carefirst Administrators. I went to the ER a week after my c section, because I couldn’t breathe. I was diagnosed with peripartum cardiomyopathy and had pulmonary edema, and was hospitalized for two nights.

My insurance company denied the claim, saying “pre certification required”. They are having Conifer Health Solutions process the claim, and Conifer tells me it wasn’t medically necessary that I be hospitalized and that instead I should have been “observed.”

The first appeal was denied. I will file the second appeal shortly—trying to give the hospital as much time as possible to send all the documentation (they say they’re working on letters of medical necessity).

Few questions:

1. Conifer says they’re denying that I should have been treated in an inpatient setting, but the bill includes “emergency room services” that were also denied. Why would that be the case? Also not exactly something I can get pre certification for… because it’s the ER.

2. The bill is only 19k. Is there an ERISA lawyer who would litigate such a small bill?

3. Any other advice for navigating this??

Edit: Oregon, late 30s