health insurance effective AFTER birth of baby

[frugalnacho]

We had a baby at the end of October.  I just received a large bill from the hospital in my son's name, dated for his birthday.  The bill shows no insurance discount, and also does not show any insurance payment.  Based on my coverage for 2017 ($500 ind deductible, $3k ind OOPM) insurance should be picking up a large portion of this bill.  When I check my explanation of benefits for my insurance it lists nothing in my son's name for his birthday (but does show all check ups and rx since).   The insurance also lists my son's insurance start date as Nov 1, which is a few days after he was actually born.

My friend, and recent new parent, warned me to pay attention to the bills because they tried delaying his coverage a couple days and wanted him to pay the full price for basically the entire bill (since it was billed as his child's birthday when his child apparently had no coverage). He said it was a major PITA to get them to resolve it and pay for the bills.  It looks like something similar may be happening here?

How do I resolve this?  I didn't change my insurance myself, I had to send documentation in to HR and they made changes.  Should I contact HR about this, or should I contact the insurance company directly?  I assume the hospital doesn't give a shit and just wants to be paid either way, but should I be contacting them to let them know I'm not paying the bill?

[honeybbq]

It's been awhile, but I thought you had to alert the insurance company right away (some ridiculous time table of course) about the birth of the baby. Did you do that? Or do you know how quickly HR did it? Sounds like you need to figure out what they did. I contacted my insurance folks myself. I think they had a form.

You child should have been covered from day 1 IME.

[NorthernBlitz]

We're in a similar situation.

We had a home birth in Sept.

Got a letter before hand that stated that it was covered. Then, afterward they said they would pay ~ 15% of the bill. My wife fought with them for while and they said they made a mistake and offered to pay ~ 40%. Then, we submitted a formal written grievance (in writing not on the phone) and received the full payment less the co-pay (what they said that they would pay in the letter we got BEFORE we had the baby).

That was for my wife's care (which was ~ 90% of the expense). We did that first, and are now pursuing getting reimbursed for my daughter's care. This was hundreds of dollars instead of thousands, so it was our second priority.

Given the crappiness of the process for my wife's reimbursement I think that we've decided to go straight to filing a grievance.

My other two daughters were born while we were still in Canada. I have to say that the US medical system is incredibly stupid. It's insane to me that such an important cog in society is all about wasting everyone's time playing rope-a-dope and hoping that the insured person gives up fighting for the coverage they pay for instead of just paying the agreed upon amount.

We felt this was especially true in our case when we had a document from the insurance company about the specific issue stating that it was covered in full. If my wife wasn't staying at home, or she had a C-Section or something that required more time to physically heal it would certainly be possible for the time to file a grievance to have passed (something most people probably don't know expires) before we filed it.

TLDR: File a written grievance with your insurance company. Don't let them take the grievance over the phone. I think we sent it by regular mail, but it may have been better to use registered mail. It's probably also good to keep detailed written records of all correspondence with them regarding this issue.

[lthenderson]

Having a baby is considered a life changing event and thus most insurance companies allow you to add a new baby to your existing policy within the first 30 days after they are born. To me this sounds like your HR department messed up and added the baby onto your insurance on the day your told them instead of the day the baby was born. I would contact them first to update your policy to reflect the baby being insured on the day it was born.

Back when we had our children, we paid our deductible to the hospital before the children were even born and that covered the entire hospital stay and the first week of checkups post hospital release. That allowed for plenty of time for our kids to get names, SSNs and such to be added fully to our health insurance policy.

[Millennialworkerbee]

Yeah I'd check with your HR department first to make sure they have coverage listed as of baby's birthday.

I did get the entire bill for the hospital charges for my son like you did (mine were correct from the beginning)  but it was a relatively easy phone call to the hospital billing department to request rerunning the charges against the health insurance.

[Livingthedream55]

If you run into any difficulty contact your state's Attorney General's Office Consumer Protection section:

http://www.michigan.gov/ag/0,4534,7-359-82100---,00.html

The Consumer Protection Practice Group manages the following divisions: Alcohol & Gambling Enforcement, Consumer Protection, Corporate Oversight, Health Care Fraud, Licensing & Regulation, and Public Service.

Practice Group Manager:
Joseph Potchen
Hours: Monday - Friday,
8:00 am - 5:00 pm ET
Email: miag@mi.gov
Phone: 517-373-1160

[mm1970]

Yes, so when kid #1 was born, the hospital billed me $3000 (for an $8400 birth).  I asked them to send me a detailed breakdown of the costs.  I then pulled out my EOB.

None of the numbers or codes added up.  Even worse, there wasn't a single combination of any charges that added up to anything on the EOB.

So.  I called the hospital, and said "I'm looking at my EOB, and I'm looking at the bill, and the numbers don't add up."  Hospital says "let us take care of that, we'll get back to you".

-Magic happens-

(I assume re-coding?)

new bill $700 (2x the deductible, one per person)


Fast forward 8 years later, I have a second kid, and he needs surgery at 9 months old.  We go to the pediatrician, get the referral to the specialist.  Specialist doesn't do surgeries on infants anymore, refers us to UCLA.  We get that through and get the official pre-approval from insurance.  Yay!

Surgery happens.  First EOB?  "We are denying coverage because it was not an emergency surgery."  No shit.  That's why we got pre-approval.

I don't mean to scare you, but it required many phone calls to UCLA, our home doctors, and the insurance company.  It eventually got fully paid, 18 months after the surgery.  Yes, 18 months (my HMO plan states that outpatient surgery costs to me are $125).



Rant:

I think that hospitals and insurance companies just fucking suck.  Insurance companies deny right out of the gate, just to see how many people are dumb enough to pay it.  Hospitals are not quite as bad, but rather than call the insurance company when they didn't cover what they should have, they just billed me for $3k anyway.

Luckily, even sleep deprived we aren't stupid.


You need to contact, HR, the hospital, and the insurance company, not necessarily in that order.

[frugalnacho]

It's been awhile, but I thought you had to alert the insurance company right away (some ridiculous time table of course) about the birth of the baby. Did you do that? Or do you know how quickly HR did it? Sounds like you need to figure out what they did. I contacted my insurance folks myself. I think they had a form.

You child should have been covered from day 1 IME.

I alerted the insurance company within a couple days.  They told me to contact HR and provide the necessary documents, which I did within a couple of days.  HR got back to me and said everything was taken care of, I got my insurance cards, and didn't even think about the "effective date" listed until I got these bills.

I've emailed HR, but my entire HR department seems really incompetent.

[mm1970]

It's been awhile, but I thought you had to alert the insurance company right away (some ridiculous time table of course) about the birth of the baby. Did you do that? Or do you know how quickly HR did it? Sounds like you need to figure out what they did. I contacted my insurance folks myself. I think they had a form.

You child should have been covered from day 1 IME.

I alerted the insurance company within a couple days.  They told me to contact HR and provide the necessary documents, which I did within a couple of days.  HR got back to me and said everything was taken care of, I got my insurance cards, and didn't even think about the "effective date" listed until I got these bills.

I've emailed HR, but my entire HR department seems really incompetent.

Our insurance company has representatives on staff to help with these issues.  That might be your best bet - to see if you've got someone like that.

[honeybbq]

It's been awhile, but I thought you had to alert the insurance company right away (some ridiculous time table of course) about the birth of the baby. Did you do that? Or do you know how quickly HR did it? Sounds like you need to figure out what they did. I contacted my insurance folks myself. I think they had a form.

You child should have been covered from day 1 IME.

I alerted the insurance company within a couple days.  They told me to contact HR and provide the necessary documents, which I did within a couple of days.  HR got back to me and said everything was taken care of, I got my insurance cards, and didn't even think about the "effective date" listed until I got these bills.

I've emailed HR, but my entire HR department seems really incompetent.

Sounds like you did everything right. Maybe just wait and see what happens after fielding a few questions.

[Proud Foot]

It's been awhile, but I thought you had to alert the insurance company right away (some ridiculous time table of course) about the birth of the baby. Did you do that? Or do you know how quickly HR did it? Sounds like you need to figure out what they did. I contacted my insurance folks myself. I think they had a form.

You child should have been covered from day 1 IME.

I alerted the insurance company within a couple days.  They told me to contact HR and provide the necessary documents, which I did within a couple of days.  HR got back to me and said everything was taken care of, I got my insurance cards, and didn't even think about the "effective date" listed until I got these bills.

I've emailed HR, but my entire HR department seems really incompetent.

Our insurance company has representatives on staff to help with these issues.  That might be your best bet - to see if you've got someone like that.

Agree with this.  Contact the insurance company to see if any of their representatives can help. Anytime there is a qualifying event to change your coverage you have 30 days to submit paperwork for any changes. The biggest other than this is getting the correct effective date for the change. It sounds like your HR probably did not get the effective date correct.

[frugalnacho]

HR is on the case.  They've email  our insurance rep, so hopefully the insurance rep is competent and can get this resolved before my bills start going to collections.