So this happened to a cousin of mine… with UHC ironically.
She randomly had a brain aneurysm (in her 30’s). Her husband took her to a local hospital in-network, they quickly found the brain bleed and told them she needed a neurosurgeon asap, and would be transferred because that smaller local hospital did not have a neurosurgeon on staff.
Transferred her by ambulance to bigger, famous state hospital. Brain surgery saved her life. 3 weeks in ICU and brain surgery = almost 500k in bills. She had full employee insurance coverage through a top 100 company at the time… and UHC denied all the claims
The reason? She wasn’t specifically admitted through the emergency room of the 2nd hospital, so they billed it as out of network entirely and refused all coverage. Really crazy shit loop hole, considering she was dying at the time and these fucks really and sincerely argued that the hospital transfer didn’t count as an emergency.
Anyways, long story short, it took her almost 2 years of fighting and getting 3rd party and legal involved. UHC finally covered about 98% of the bill, but stuck her with 20k she’s still fighting.
American healthcare is an absolute shit show.