J. and K. had their daughter A. in early 2025. A few hours post-delivery her bilirubin levels triggered transfer to the level-3 NICU at a downtown sister facility for intensive phototherapy. She was back home in 72 hours.
The bills started arriving four weeks later: one from the delivery hospital, one from the downtown NICU, both itemized with phototherapy hour-blocks that overlapped. The total ask landed at $28,400; after their plan applied an out-of-network discount on the downtown facility (their plan considered it OON despite being in the same system), the member responsibility settled at $11,200.
Audra's audit cross-referenced the two itemized statements. The delivery hospital billed phototherapy at the same hour ranges the downtown facility billed — including a four-hour window during the ambulance transfer when no phototherapy could possibly have been happening at either site. Net: $9,800 in clearly-duplicate charges across the two bills, plus a no-surprises-act case for the OON designation on a same-system transfer.
Audra drafted two appeals in parallel: one to the delivery hospital's billing team about the duplicated phototherapy hours, and one to the insurer about the No Surprises Act protection. Both succeeded. J. and K. paid $1,400 in the end.