Molina Healthcare denied payment for Jan Anderson’s April 2025 hospitalization after transient global amnesia was worked up as possible stroke, saying inpatient authorization was required — leaving $59,181 in charges unresolved for more than a year despite federal No Surprises Act protections and an explanation of benefits showing $0 patient responsibility. Clinically, the case underscores a familiar reality: emergency neurologic symptoms that appropriately trigger rapid stroke-rule-out care can still generate prolonged billing exposure even when the final diagnosis is benign.

The Move

• A 65-year-old woman developed sudden repetitive questioning after a hike in Sedona, Arizona, was evaluated for possible stroke, airlifted to an Abrazo Health hospital near Phoenix, and was later found to have probable transient global amnesia, a temporary benign Disease of the nervous system.

• The hospital billed $59,181, including $35,302 for imaging, $8,147 for labs, $8,146 for special care, $5,532 for EKG services, and $2,054 for pharmacy.

• Molina, her Affordable Care Act marketplace insurer at the time, denied the inpatient claim, arguing prior authorization or notification was required after admission.

• After inquiries from KFF Health News, Abrazo told Anderson the balance would be written off if Molina still refused payment.

Why it Matters for Care

• At the bedside, transient global amnesia can mimic stroke early enough that clinicians must act fast; the workup here included ECG, imaging, and labs commonly used to exclude cerebrovascular disease.

• For hospitalists, ED clinicians, neurologists, and case managers, the case is a reminder that emergency stabilization and transfer documentation matter not just clinically but financially when out-of-network facilities and observation-versus-inpatient status come into play.

• Patients may receive alarming bills that conflict with their insurer’s explanation of benefits; what matters most is the stated patient responsibility, which in this case was $0.00.

• Clear discharge counseling should include who is handling authorization disputes and when patients should escalate to billing offices, insurers, or regulators.

Between the Lines

• The dispute appears to reflect an administrative handoff failure: Anderson’s insurance information was reportedly not transferred from the first ER to the receiving hospital.

• The core tension is incentive-driven: plans scrutinize post-stabilization inpatient claims, while hospitals expect payment for emergency transfers that begin under stroke protocols.

• The No Surprises Act broadly protects patients from out-of-network emergency bills, but implementation can still break down when emergency care transitions into admission status.

• Second-order effect: even when patients are unlikely to owe the balance, unresolved five-figure claims can create months of stress and may deter future emergency care-seeking.

What to Watch

• Whether insurers and hospitals tighten workflows for transferring coverage data during interfacility emergency transfers.

• Whether federal or state regulators issue more explicit guidance on how No Surprises Act protections apply once emergency evaluation becomes inpatient care.

• Whether health systems give patients written confirmation of zero balance sooner, rather than verbal assurances after media or regulator involvement.

• For clinicians, expect continued patient questions about EOBs, balance bills, and out-of-network emergency care — especially in neurology and stroke-rule-out cases.

Source: KFF Health News