EXCLUSIVE: Makiki man, health insurer at odds over $120K bill

EXCLUSIVE: Makiki man, health insurer at odds over $120K billing dispute
Christopher Woo (Image: Hawaii News Now)
Christopher Woo (Image: Hawaii News Now)
Image: Hawaii News Now
Image: Hawaii News Now
Rafael del Castillo (Image: Hawaii News Now)
Rafael del Castillo (Image: Hawaii News Now)
Zachary Woo (Image: Hawaii News Now)
Zachary Woo (Image: Hawaii News Now)

HONOLULU (HawaiiNewsNow) - Zachary Woo was once one of the state's top high school swimmers before pain in his groin and hips slowed him down.

Two years ago, the 2014 Punahou grad opted for surgery with a specialist in Colorado, after UHA Health Insurance initially approved the plan and estimated his out-of-pocket costs would be $2,200, his father Christopher Woo said.

But just days before his surgery, UHA told the Woos it wouldn't cover the procedure because it could be done in Hawaii, the elder Woo said.

"He went ahead and did the surgery and then we got hit with a bill for $120,000," said Christopher Woo.  "It was a shock to me when this all unfolded. But we were stuck."

Such "balance bills" aren't exactly uncommon for patients. They represent the significant medical tabs patients can accrue if they go to a healthcare provider outside of their insurer's network.

A measure to be heard by the House Consumer Protection Committee on Monday aims to address billing disputes like these by requiring insurers to disclose the cost of treatment by out-of-network providers.

The bill also requires insurers to charge emergency room patients treated by out-of-network providers the same rate that they charge patients treated in emergency rooms that are part of their network.

Insurers and healthcare providers said federal law provides adequate safeguards.

But Woo's attorney, Rafael del Castillo, said the problem is more prevalent than the healthcare industry admits.

"I have seen surgeries, heart (problems) and bladder cancer that have been denied and we've had to go to litigation to get those paid," del Castillo said.

He said UHA has a lot of these billing disputes because many of the mainland providers listed in the network are not under contract.

"They don't have the provider network on the mainland, in fact their plan ... is a network of nonparticipating doctors," he said.

UHA declined comment on the Woos' dispute due to federal privacy laws.

But in a statement, UHA CEO Howard Lee said, "UHA fully informs the member of the potential financial obligations that they will be responsible for in choosing to self-refer.

"In the rare instance that comparable care is not available here or for those members who still elect to self-refer and seek mainland care, UHA's team of on-staff physicians and nurses have the expertise to coordinate out-of-state care and are here to help our members every step of the way."

The billing dispute is now being reviewed by the state Insurance Division.

As for Zachary Woo, he's fully healed and is now a member of Boston University's swim team.

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