The Pitt Keeps Asking Who’s Covered

  • Insurance Discovery
  • Prior Authorizations
  • Revenue Cycle Management

HBO Max’s The Pitt has been praised for how accurately it captures an urban emergency department. The waiting room never empties, admitted patients board for hours waiting on a bed upstairs, and staff move from case to case with no slack anywhere in the day.

The show is clear-eyed about what that pace costs clinically. There’s a financial version of the same problem: the patients filling those waiting rooms increasingly arrive without confirmed coverage, and the work of sorting that out lands on people who have no spare hour to give.

The Strain Behind the Waiting Room

Emergency departments are absorbing more uninsured patients every year. Virginia hospitals alone recorded more than 400,000 self-pay emergency department visits in 2025, up 8% from the prior year and 49% since 2022. Nationally, hospitals have provided almost $745 billion in uncompensated care since 2000.

Registration teams are working more encounters per shift, and a larger share of them open with an unanswered question about who pays.

Care First, Coverage Questions Later

Under EMTALA, an emergency department screens and stabilizes anyone who comes through the door, regardless of ability to pay or whether they can produce an insurance card. The hospital commits staff, imaging, supplies, and bed time before anyone confirms there’s a payer on the other end. Checking by hand means payer phone calls and portal logins, and accounts slip through.

Many self-pay patients have no coverage, while for others their coverage has lapsed. Checking manually means payer phone calls and portal logins, and it’s easy for accounts to slip through the cracks.

How Automation Protects Revenue in the ED

maxRTE Insurance Discovery searches unknown commercial, exchange, and government plans along with workers’ comp, TPAs, and COBRA, and finds billable coverage on as much as 25% of self-pay accounts. It runs in real time in the ED, and across look-back periods for accounts already sitting in self-pay, so accounts get checked whether or not anyone had time to make the call.

Missing billable coverage also means missing the Notice of Admission. Payers hold hospitals to strict 24 to 48 hour deadlines, and a late notice denies a stay the hospital has already delivered. That risk concentrates in the ED, where roughly 70% of hospital inpatients are admitted. Epic triggers the NOA to maxRTE the moment the admission order is placed, and maxRTE files it against payer-specific requirements and writes the status back to the chart, so the deadline doesn’t rest on someone remembering it mid-shift.

Urban EDs aren’t getting quieter, and the self-pay share isn’t trending down. Automating insurance discovery and admission notices takes the coverage question off the front-end team, so staff spend their shift on patients rather than on administrative work. maxRTE Insurance Discovery uncovered over one billion dollars of revenue for health systems across the U.S. that otherwise would have been written off to bad debt.

maxRTE helps hospitals and health systems reduce denials, uncover hidden coverage, and accelerate payments, all through automation built directly into your EHR. Schedule a demo today.