u/shaneZhang

My newborn daughter developed seizures on her second day of life while we were at WakeMed Cary Hospital (North Carolina).
The pediatric/neonatal team determined that she needed urgent NICU care with continuous EEG monitoring and further evaluation (she was later diagnosed with neonatal stroke). We did **not** choose where she would go.
According to the physician, Duke NICU was contacted first but had no available NICU beds, so my daughter was transferred to WakeMed Raleigh NICU instead. Unfortunately, the medical record does not explicitly document that Duke had no beds.
Our insurance plan is **UnitedHealthcare Choice Plus PPO**. WakeMed Raleigh is considered **out-of-network** under our plan.
We’re now seeing claims showing that most of the NICU hospitalization was processed as out-of-network, and it looks like we could be responsible for around half of the charge, and max-out-of-pocket does not apply.
I first contacted WakeMed Raleigh and asked whether No Surprise Act might apply and the claim can be treated as in-network charge, and they said I need to get a continuity-of-care first, then the claim can be processed as in-network. We did have continuity-of-care for WakeMed Cary, but that only covered the most basic CPTs.
I called UHC and asked whether the **No Surprises Act** might apply. They did not give me a direct answer but agreed to **re-review the claim** after rounds of talks. Before that, they suggested me to contact NaviGurad, which helps with the negotiations between out-of-network providers.
My questions are:
1.Does the **No Surprises Act** apply to situations like this, where parents had no choice in the transfer destination?
2.What type of documentation was most helpful? Has anyone been able to obtain a letter confirming that an in-network NICU had no available beds?
3.Is there anything else I should be doing while UHC is reviewing the claim?
Any advice or similar experiences would be greatly appreciated. Thank you!

My newborn daughter developed seizures on her second day of life while we were at WakeMed Cary Hospital (North Carolina).
The pediatric/neonatal team determined that she needed urgent NICU care with continuous EEG monitoring and further evaluation (she was later diagnosed with neonatal stroke). We did not choose where she would go.
According to the physician, Duke NICU was contacted first but had no available NICU beds, so my daughter was transferred to WakeMed Raleigh NICU instead. Unfortunately, the medical record does not explicitly document that Duke had no beds.
Our insurance plan is UnitedHealthcare Choice Plus PPO. WakeMed Raleigh is considered out-of-network under our plan.
We’re now seeing claims showing that most of the NICU hospitalization was processed as out-of-network, and it looks like we could be responsible for around half of the charge, and max-out-of-pocket does not apply.
I first contacted WakeMed Raleigh and asked whether No Surprise Act might apply and the claim can be treated as in-network charge, and they said I need to get a continuity-of-care first, then the claim can be processed as in-network. We did have continuity-of-care for WakeMed Cary, but that only covered the most basic CPTs.
I called UHC and asked whether the No Surprises Act might apply. They did not give me a direct answer but agreed to re-review the claim after rounds of talks. Before that, they suggested me to contact NaviGurad, which helps with the negotiations between out-of-network providers.
My questions are:
1.Does the No Surprises Act apply to situations like this, where parents had no choice in the transfer destination?
2.What type of documentation was most helpful? Has anyone been able to obtain a letter confirming that an in-network NICU had no available beds?
3.Is there anything else I should be doing while UHC is reviewing the claim?
Any advice or similar experiences would be greatly appreciated. Thank you!