Silvana Toska was playing in a grass field with her daughters late last fall when she felt a sting on her ankle. The family had come to listen for barred and great horned owls as the sun set on a large park near their Davidson, North Carolina, home.
It was “just like a mosquito bite, nothing major, and I just scratched it,” said Toska, a political science professor.
Then she began to itch everywhere. She couldn’t see anything in the dark, so her husband shined his phone light on her.
She was covered in hives.
Because she also felt pressure in her chest, the family quickly went to an urgent care clinic. A doctor there recognized she was experiencing anaphylactic shock, a life-threatening, fast-moving allergic reaction.
The doctor rushed her to a room without checking her in, saw her blood pressure was low, and administered two epinephrine injections and IV fluids, Toska said. The itching stopped, and the tightness in her chest went away.
But the doctor said she needed to be monitored in an emergency room for at least two hours in case the reaction flared up again. Toska said the doctor insisted she take an ambulance to a nearby hospital, Atrium Health Lake Norman.
Minutes later, she found herself lying on a stretcher in the ER.
A doctor she described as “lovely” came in and spoke to her for no more than five minutes, Toska said. A nurse administered medicine through the IV line inserted at the urgent care clinic.
Toska was exhausted, but her mind was on her daughters. “I had two little kids who were scared, so I was playing with them and trying to distract them.”
After about an hour and a half, the doctor returned briefly, then the family went home, she said.
“That’s it,” Toska said. “Nothing happened at the ER.”
Then the bill came.
The Medical Service
Toska said the ER doctor reviewed her vitals and discussed her allergic reaction and what to watch for when she got home. She also received a dose of famotidine, a drug often used to treat an upset stomach that is also administered for allergic reactions.
The Bill
The in-network hospital system charged Toska’s insurer, Blue Cross Blue Shield of North Carolina, $6,746.50 for the ER visit, including $20.60 for the famotidine and $6,445.60 in “critical care” charges. Toska, who had not met her insurance deductible, was responsible for a $150 copay and $3,100.24 of the charges.
This <a target="_blank" href="https://kffhealthnews.org/health-industry/er-monitoring-anaphylactic-shock-allergic-reaction-bill-of-the-month-april-2026/">article</a> first appeared on <a target="_blank" href="https://kffhealthnews.org">KFF Health News</a> and is republished here under a <a target="_blank" href="https://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150" style="width:1em;height:1em;margin-left:10px;">
