Unfortunatley, being a w/c patient the insurer can rightly deny any and all ER claims. You need to be followed up by your w/c physician. Go often, go as much as you need to go relating to your injury. I found out the ER issue the hard way. So, its true. The rules state you must get permission to go to the ER from the insurer. LOL...so when do we know when the ER is needed? O yeah, I plan on having SOB, my extremities will be turning blue and pain so high it cannot breathe on Saturday 1:56am. Its called dictated medical care. However, the insurer will pay for true life threatening conditions which they put conditions on.

1 instance I had a severe reaction to a medication...I went to the ER from work and was reprimanded by the insurance company that i should have gone to the clinic. They couldnt have helped me, I needed ER attention and meds the clinic didnt offer. Another time I couldnt breathe not knowing I developed pleurisy from a w/c procedure needle poke. Well, I had to have a PET, MRI's & CAT with contrast, then drain my lungs as in a thoracentesis. 2 weeks worth of testing and hospitalizations. They refuse to pay for it to this day since it was not approved before going to the ER. It was a weekend. What is a person supposed to do?