We conducted a survey of managed care plan (MCP) patients who presented to the emergency department (ED) but were denied insurance authorization during a 3-month period. Patients were identified by triage or registration records, contacted by telephone after their visit, and surveyed regarding their satisfaction with the ED and MCP, follow-up care, and future behavior. We surveyed 72 (73.4%) of 98 subjects who were denied authorization. Forty-nine (68.1%) were redirected to a clinic or primary physician, 14 (19.4%) to an urgent care or other ED, and 9 (12.5%) were given no follow-up. Fifty-five respondents (76.4%) stated they had followed-up as directed, but 34 (47.2%) felt the delay had a negative impact. Thirty-nine (54.2%) were dissatisfied with their MCP. If their problems were to recur, 27 (37.5%) stated they would go to a clinic or call their MCP, but 34 (47.2%) would return to the ED. Many patients who are denied authorization are dissatisfied with their MCP and will return to the ED in the future, despite previous denials.