Couple fights balance billing, saves thousands

Couple fights balance billing, saves thousands

(KPRC) For Cheri Oberhoff and her loving husband Ray, giving Ray his daily medication has become a morning ritual. He needs a whole box full of expensive prescription drugs to get by.

You see, for 18 years, Ray risked his life saving others as a Houston firefighter. He battled blazes, charged into burning homes, climbed steep rooftops and carried the sick and injured. That is, until his body finally gave in.

"I loved my job more than anything," Ray said, with tears running down his cheeks. "One day I carried a guy on the stretcher that was probably over 450 pounds, suddenly I felt a pop in my back and that was the end of my career."

You would think Ray has battled enough, but you would be wrong.

Earlier this year, Ray had to undergo a complete knee replacement. So everything would be covered under his medical plan, Ray went to an in-network hospital and saw an in-network surgeon.

But then, Cheri and Ray suddenly got a bill for almost $9,000 from an anesthesiologist who worked on Ray and was out-of-network. The Oberhoffs were stunned by the size of that bill.

"I saw the numbers and I said 'This can't be for real,'" Ray said. "I mean, almost $9,000, we shouldn't have to pay."

Ray and Cheri had just entered into the brutal world of balance billing. It's a practice where doctors, hospitals, labs and technicians who are not connected to your health plan, charge you huge fees to make up for the money they can't collect from your insurance company.

That's when the Oberhoffs saw my investigative report on how to fight balance billing and, using that information and Cheri's direct knowledge of medical insurance -- she used to work for several large health insurance companies -- the Oberhoffs decided to fight that big bill.

How did they do it?

Step one, Cheri carefully studied the explanation of benefits, comparing directly with the medical bill she had received from the anesthesiologist.

Then, she contacted her health insurance company to make sure no mistakes were made and that all items were processed correctly.

"I contacted our insurance carrier to make sure they processed it right, and I asked if it needed to be re-processed," Cheri said.

Step two, Cheri contacted the out-of-network anesthesiologist directly and attempted to negotiate the charges.
She told his office exactly what happened, how she had done everything she could to make sure all Ray's care would be in-network.

Step three, Cheri went beyond that doctor's office and contacted the billing service for that doctor.

She told the billing people the same story, how she and her husband had done everything right. She told them how they had specifically found an in-network facility and an in-network doctor.

And finally, she told them that she and her husband were being treated unfairly and that they deserved a big discount off that huge medical bill.

It took six emails and five months, but in the end, Cheri and Ray saw that nearly $9,000 anesthesiologist bill reduced to just $335.

"I was elated," Cheri said. "And my husband was thrilled."

Altogether, the Oberhoffs saved more than $8,000.

If you have been a victim of balance billing and you want to fight the bill, medical billing expert Shawn Fry, CEO of Prevalent Health said, "By all means, contact the doctor or the billing service and argue to have that bill greatly reduced. You don't lose anything by trying, and most of these people will work with you."

If that doesn't work, Fry advises you contact your health plan and ask them to battle to get that bill knocked down for you.

Finally, Fry said to fight balance billing before it ever starts by asking a simple question before you have your procedure.

"Ask if the fees you are going to be charged are the global fees," Fry said. "In other words, is everything, every medical service, included. Tell them if there will be out-of-network doctors, or labs, or technicians working with you, you want to be charged the in-network rate."