Health insurance for newborn period: coinsurance confusion

[naners]

Hi gang, I'm hoping that someone has the expertise to help clear up some confusion for me. My son was born last summer, and as I understand it the newborn is automatically covered by both parents' insurance. Apparently the "birthday rule" determines which parent's insurance is the primary insurer: my husband's birthday is earlier in the year so his insurance is supposed to be the primary insurer. We then added my son to my insurance within the 30 day window, so my insurance became the sole and primary insurance.

The issue is that my husband's insurance is claiming that my son was not enrolled on the relevant dates, and my insurance will only pay out as secondary, so the hospital is billing us for the difference. Am I missing something about how this works? How can my son have not been enrolled under my husband's insurance if he's automatically covered as a newborn?

God I hate health insurance.

[Altons Bobs]

You have to enroll him, he's not automatically enrolled. If you guys didn't request for him to be added to your husband's coverage, then he's not on his coverage at all.

[wordnerd]

Yeah, we had to call within 60 days (I think) to get our son on my plan. It took several phone calls (because...insurance companies) and was definitely not automatic.

[mm1970]

You have to enroll him, he's not automatically enrolled. If you guys didn't request for him to be added to your husband's coverage, then he's not on his coverage at all.

This.

He would be retroactively covered, for example, if you had added him to husband's insurance.  Or if you didn't have a job, and his was the only insurance.  (You still have to add him.)

[I'm a red panda]

Where do you live? What jurisdiction automatically enrolls a newborn?

That might help answer the question.

But from my point of view- newborns are not automatically covered under parents insurance. My hospital worked under the assumption the baby would be enrolled in the mother's insurance, but it was up to me to make that happen.

[MommyCake]

Hi Naners,
I think I know where your confusion lies....

Before my daughter was born, we decided to have her go on her father's insurance, because the cost to add her to mine was very high.  The problem was that the coverage didn't start immediately, the coverage would start when she came home from hospital... because I am not on her father's insurance, the "newborn" hospital coverage would have to paid for by my insurance.  When I called my health insurance to see if this would be covered, they said something along the lines of "oh yes newborns are covered by the mothers insurance automatically, but only until the newborn is released from the hospital following birth.  If you want to cover her under your plan you have to fill out form xyz" 

Your insurance would have only covered the baby automatically for the newborn hospital bills, but to keep the coverage you have to actually enroll... if the same rules apply.

[vivian]

If you signed your newborn up for your insurance within your employer’s stated window, he should be covered retroactive to birth on your insurance.

However, insurance companies will always try to deny claims. A similar thing happened to us. We signed our newborn up on my insurance (Aetna), and never told the hospital about my husband’s insurance because we did not sign her up for that. Aetna, all on their own, found out my husband is covered by BCBS, which has a clause that says newborns are covered since birth. They ignored the clause right after that about “assuming you sign them up within this period.” Aetna kept refusing to be primary. We had to get a letter from BCBS stating our newborn was not covered, and threatened to call the state insurance commission before Aetna would pay what was a valid claim.

My advice is to get such a letter. And keep in touch with the hospital. They know insurance companies are hard to deal with, and can also give you advice on how to deal with this.


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[NextTime]

Interesting.

I guess we never had to worry about it since my wife was on my insurance. We just had to fill out a form in the 30 day window and provide a copy of the birth certificate and social security card, and it was taken care of.

I would think that the legal thing would be for the insurance you added the child to (Aetna?) to retroactively cover the birth.

[ltt]

Did you enroll your child within the 30-day window?  Did you fill out a copy of the form?  If so, did you keep a copy of the form?  Or did you note on the form what date you turned it into HR?  Any more, you can go online to see the date the family member had coverage.