Help!

Hello. My name is Greta and I am somewhat of a newcomer. I am in
quite a predicament and I wonder if anyone has any suggestions. I got
a statement from my insurance company for my daughter's birth, and it
stated that they will not cover anything because she was not on the
policy. I figured that it was a mistake. My boss told me that she was
automatically covered for the first 30 days, and if I wanted to keep
her on my policy I would have to call him and have her added. He was
trying to persuade me against doing this, and told me that I would have
to pay the difference ($5oo per month) myself. We ended up putting her
on my husbands insurance policy after the 30 days. I called the
insurance company and told them what happened, and they said that I had
to fill out an enrollment paper for her within 30 days after her birth,
and because I didn't do that, I am now responsible for the cost myself.
I didn't recieve the statement util 50 days after her birth, and they
said there is nothing I can do now. Well my daughter was in intensive
care for 10 days, so the bill is for $16,000! I am just kicking myself
for not calling to check but I had a high risk pregnancy and was on bed
rest for 6 weeks. I ended up having a C section at 35 weeks. I am so
stressed out about this. Does anyone have any advice for me or know if
there is anything I can do?

Greta, you don't mention where you are so I will assume in the US.

GMR wrote:
a statement from my insurance company for my daughter's birth, and it
stated that they will not cover anything because she was not on the
policy.

Babies are covered for 30 days on their mother's policy.

We ended up putting her
on my husbands insurance policy after the 30 days.

I assume you did this before the 30 days had elapsed. Quite normal.


I called [my]
insurance company and told them what happened, and they said that I had
to fill out an enrollment paper for her within 30 days after her birth,
and because I didn't do that, I am now responsible for the cost myself.

You have 30 days to enroll the baby in a parent's insurance policy,
for coverage from then on.

Coverage during the baby's first 30 days outside the uterus comes
under whatever policy covers the mother at the time of delivery.

Whether or not a piece of paper is required, I don't know, but I
doubt it. It's not like the insurance company didn't know about
the pregnancy. KWIM?

I suggest you call your hospital's billing office and/or patient
advocate, and ask them for advice.

Pologirl wrote:


We ended up putting her
on my husbands insurance policy after the 30 days.

I assume you did this before the 30 days had elapsed. Quite normal.

I interpreted her statement above to say that the
baby was put on the husband's insurance policy *AFTER* the
30 days had elapsed, hence the problem. It's not quite
true that the baby is covered under the mother's insurance
for 30 days. They baby must be added as a dependent to
be covered. What happens is that there's a 30 day grace
period to get the baby enrolled. When you miss out on that
30 day (or 31 day) grace period, then none of the baby's care
is covered.
Unfortunately, I'm not aware of any way around this
situation if you didn't add the child within the 30 day window.

Best wishes,
Ericka

GMR wrote:
Hello. My name is Greta and I am somewhat of a newcomer. I am in
quite a predicament and I wonder if anyone has any suggestions. I got
a statement from my insurance company for my daughter's birth, and it
stated that they will not cover anything because she was not on the
policy. I figured that it was a mistake. My boss told me that she was
automatically covered for the first 30 days, and if I wanted to keep
her on my policy I would have to call him and have her added. He was
trying to persuade me against doing this, and told me that I would have
to pay the difference ($5oo per month) myself. We ended up putting her
on my husbands insurance policy after the 30 days. I called the
insurance company and told them what happened, and they said that I had
to fill out an enrollment paper for her within 30 days after her birth,
and because I didn't do that, I am now responsible for the cost myself.

It sounds like your boss was wrong vis a vis the insurance company
guidelines; in some cases there's a mom/baby bill for birth and x hours
(48 here), but after that the baby is a separate entity for billing and
insurance purposes. Geez, this sounds like bad luck. I'm sure that your
boss was trying to save you money (although cynically I think 'and
maybe keep her own group rates lower'), and it sounds like a horrible
miscommunication. Oy.

I didn't recieve the statement util 50 days after her birth, and they
said there is nothing I can do now.

Talk with the 'they' again -- say that you can't pay $16k for starters
(unless you can easily). That your baby was uninsured, are their
programs for uninsured, et cetera. Confirm *exactly when* your baby's
insurance lapsed, per their guidelines, and *exactly when* it picked up
on the other policy. If your baby was born in a (US) hospital, ask to
speak with the hospital's ombudsperson to set up some sort of payment
plan. Do not charge $16k on your credit card. See if you can get the
contracted (insured) rate for the PICU services, versus the uninsured
rate.

Well my daughter was in intensive
care for 10 days, so the bill is for $16,000! I am just kicking myself
for not calling to check but I had a high risk pregnancy and was on bed
rest for 6 weeks. I ended up having a C section at 35 weeks. I am so
stressed out about this. Does anyone have any advice for me or know if
there is anything I can do?

Agh. Bad luck. Also, talk with your boss about this and see if she has
any ideas.

Best of luck,

Caledonia

"Ericka Kammerer" wrote in message
...
Pologirl wrote:


We ended up putting her
on my husbands insurance policy after the 30 days.

I assume you did this before the 30 days had elapsed. Quite normal.

I interpreted her statement above to say that the
baby was put on the husband's insurance policy *AFTER* the
30 days had elapsed, hence the problem. It's not quite
true that the baby is covered under the mother's insurance
for 30 days. They baby must be added as a dependent to
be covered. What happens is that there's a 30 day grace
period to get the baby enrolled. When you miss out on that
30 day (or 31 day) grace period, then none of the baby's care
is covered.
Unfortunately, I'm not aware of any way around this
situation if you didn't add the child within the 30 day window.

Best wishes,
Ericka


So, to clarify for my own use, if the baby is put on the father's insurance
policy within the 30 days after birth, does the father's insurance company
cover retroactively to birth? I couldn't figure out if you meant that the
baby needs to be added to the mother's insurance policy in order to be
covered, or just *someone's* insurance policy. We plan to use DHs insurance
for the baby, but I'll still be on my own insurance. Do you see any
problems likely to arise from this?

For the OP, it's worth a call to your DHs insurance company to see if they'd
cover anything retroactively. They'd have to be really nice to do so, but
sometimes they like the public relations. Also, talk to the hospital
patient advocate and see if you can get financial aid or reduction in price.
They could even resubmit the bills to the new insurance company and see if
they'll cover it (sometimes they don't pay as close attention as they
should).

Thanks,
Amy

V. wrote:

"Ericka Kammerer" wrote in message
...

Pologirl wrote:



We ended up putting her
on my husbands insurance policy after the 30 days.

I assume you did this before the 30 days had elapsed. Quite normal.

I interpreted her statement above to say that the
baby was put on the husband's insurance policy *AFTER* the
30 days had elapsed, hence the problem. It's not quite
true that the baby is covered under the mother's insurance
for 30 days. They baby must be added as a dependent to
be covered. What happens is that there's a 30 day grace
period to get the baby enrolled. When you miss out on that
30 day (or 31 day) grace period, then none of the baby's care
is covered.
Unfortunately, I'm not aware of any way around this
situation if you didn't add the child within the 30 day window.

So, to clarify for my own use, if the baby is put on the father's insurance
policy within the 30 days after birth, does the father's insurance company
cover retroactively to birth? I couldn't figure out if you meant that the
baby needs to be added to the mother's insurance policy in order to be
covered, or just *someone's* insurance policy. We plan to use DHs insurance
for the baby, but I'll still be on my own insurance. Do you see any
problems likely to arise from this?

I'm not 100 percent clear on this, so I would verify
it with the insurance companies. There's certainly a way to
do it, as it's a common situation, but I'm not sure how the
details get ironed out. I would assume that Dad's insurance
covers retroactively, because Dad's insurance should *also*
say that newborns are covered from the moment of birth with
a 30 day grace period to formally add the baby, but it's never
wise to assume anything with insurance companies--for all you
know, his insurance has a 30 day grace period, but only if
you stand on your head and whistle "Dixie" ;-)

For the OP, it's worth a call to your DHs insurance company to see if they'd
cover anything retroactively. They'd have to be really nice to do so, but
sometimes they like the public relations. Also, talk to the hospital
patient advocate and see if you can get financial aid or reduction in price.
They could even resubmit the bills to the new insurance company and see if
they'll cover it (sometimes they don't pay as close attention as they
should).

That's absolutely true. I've had a couple things covered
that theoretically the insurance company didn't cover. Coverage
dates are something they usually *do* check carefully, but it's
worth a shot.

Best wishes,
Ericka

V. wrote:
"Ericka Kammerer" wrote in message
...
Pologirl wrote:


We ended up putting her
on my husbands insurance policy after the 30 days.

I assume you did this before the 30 days had elapsed. Quite normal.

I interpreted her statement above to say that the
baby was put on the husband's insurance policy *AFTER* the
30 days had elapsed, hence the problem. It's not quite
true that the baby is covered under the mother's insurance
for 30 days. They baby must be added as a dependent to
be covered. What happens is that there's a 30 day grace
period to get the baby enrolled. When you miss out on that
30 day (or 31 day) grace period, then none of the baby's care
is covered.
Unfortunately, I'm not aware of any way around this
situation if you didn't add the child within the 30 day window.

Best wishes,
Ericka


So, to clarify for my own use, if the baby is put on the father's insurance
policy within the 30 days after birth, does the father's insurance company
cover retroactively to birth?

[The 30 days varies by policy, b/t/w. Your policy may differ from this.
Please check your policy. ] Generally, birth is covered under a blanket
mom and baby professional/facility bill -- anything *not birth* for the
baby following the Mom's discharge is a separate entity (or separate
bill), if that makes sense. So in this case, the birth and baby R&B
would be covered, but the NICU is a whole different animal.

I couldn't figure out if you meant that the
baby needs to be added to the mother's insurance policy in order to be
covered, or just *someone's* insurance policy.

The baby needs to be on *someone's* insurance policy after it is born
and incurring his/her own medical bills. In your case, whether this
kicks you into an employee+1 or employee+family category is based on
both your (or DH's) insurance and how the HR department(s) contracted
with the insurers.

We plan to use DHs insurance
for the baby, but I'll still be on my own insurance. Do you see any
problems likely to arise from this?

None that I can see; DH needs to update his insurance (and
premiums/deductions, if applicable), and should give them a call
*prior* to the birth to let them know this will be happening. It's a
qualifying event. What strikes me as different is that presumably the
baby had a WBV in the first 30 days of life, or *something* in the
first 30 days (a separate admission? a specialist visit?), and
presumably insurance coverages were checked then, and the issue of
lapsed coverage was raised, or the financial counselors were wildly
remiss.

For the OP, it's worth a call to your DHs insurance company to see if they'd
cover anything retroactively. They'd have to be really nice to do so, but
sometimes they like the public relations. Also, talk to the hospital
patient advocate and see if you can get financial aid or reduction in price.
They could even resubmit the bills to the new insurance company and see if
they'll cover it (sometimes they don't pay as close attention as they
should).

Admittedly, insurance companies do miss things, but we all get the
opportunity to pay for them later, one way or the other.

For me (but it's just me), it strikes me as odd that the OP was told by
her boss that her annual premium would jump $6k to add the baby
(employee+child is typically cheaper than employee+spouse because
spouses are, well, older and more expensive), sometime after this NICU
experience. Dunno. Can't shake the feeling though that the boss is in
some way implicated in...something.

Caledonia

"V." wrote in message
...

"Ericka Kammerer" wrote in message
...
Pologirl wrote:


We ended up putting her
on my husbands insurance policy after the 30 days.

I assume you did this before the 30 days had elapsed. Quite normal.

I interpreted her statement above to say that the
baby was put on the husband's insurance policy *AFTER* the
30 days had elapsed, hence the problem. It's not quite
true that the baby is covered under the mother's insurance
for 30 days. They baby must be added as a dependent to
be covered. What happens is that there's a 30 day grace
period to get the baby enrolled. When you miss out on that
30 day (or 31 day) grace period, then none of the baby's care
is covered.
Unfortunately, I'm not aware of any way around this
situation if you didn't add the child within the 30 day window.

Best wishes,
Ericka


So, to clarify for my own use, if the baby is put on the father's
insurance
policy within the 30 days after birth, does the father's insurance company
cover retroactively to birth? I couldn't figure out if you meant that the
baby needs to be added to the mother's insurance policy in order to be
covered, or just *someone's* insurance policy. We plan to use DHs
insurance
for the baby, but I'll still be on my own insurance. Do you see any
problems likely to arise from this?

For the OP, it's worth a call to your DHs insurance company to see if
they'd
cover anything retroactively. They'd have to be really nice to do so, but
sometimes they like the public relations. Also, talk to the hospital
patient advocate and see if you can get financial aid or reduction in
price.
They could even resubmit the bills to the new insurance company and see if
they'll cover it (sometimes they don't pay as close attention as they
should).

Thanks,
Amy



Amy,
When we brought both of our girls home I was a stay at home mom, so only
covered by my dh's insurance. Both times we informed the insurance company
of the new addition to the family within the 30 day period (like within the
first week), and both times it was covered.
--

Jamie
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sting! : (
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Caledonia wrote:

For me (but it's just me), it strikes me as odd that the OP was told
by her boss that her annual premium would jump $6k to add the baby
(employee+child is typically cheaper than employee+spouse because
spouses are, well, older and more expensive), sometime after this NICU
experience. Dunno. Can't shake the feeling though that the boss is in
some way implicated in...something.


I think her boss was just trying to save her some money. She was going to
put the baby on her dh's insurance so why would she want to pay premiums on
her insurance? Her boss had no way of knowing that she'd miss the deadline
on dh's insurance. Many insurances have an all or nothing policy.
Individual or family..you can't add just a spouse or just a kid. Mine is
like that and it is over $500 per month. Dh can now move the kids to his
policy but he didn't do it when he was first hired and so now the kids have
to wait 18 months to move over to his policy because they are currently
insured. That will cost us over 6K :-P.
--
Nikki

GMR wrote:
Hello. My name is Greta and I am somewhat of a newcomer. I am in
quite a predicament and I wonder if anyone has any suggestions. I got
a statement from my insurance company for my daughter's birth, and it
stated that they will not cover anything because she was not on the
policy. I figured that it was a mistake. My boss told me that she
was automatically covered for the first 30 days, and if I wanted to
keep her on my policy I would have to call him and have her added.
He was trying to persuade me against doing this, and told me that I
would have to pay the difference ($5oo per month) myself. We ended
up putting her on my husbands insurance policy after the 30 days. I
called the insurance company and told them what happened, and they
said that I had to fill out an enrollment paper for her within 30
days after her birth, and because I didn't do that, I am now
responsible for the cost myself. I didn't recieve the statement util
50 days after her birth, and they said there is nothing I can do now.
Well my daughter was in intensive care for 10 days, so the bill is
for $16,000! I am just kicking myself for not calling to check but I
had a high risk pregnancy and was on bed rest for 6 weeks. I ended
up having a C section at 35 weeks. I am so stressed out about this.
Does anyone have any advice for me or know if there is anything I can
do?

I think the person you need to be talking to is your insurance. Many
policies *do* have an automatic 30 day coverage for newborns even if you
don't sign them up for continued coverage. Insurances mess up all the time
so don't let that one go. Her coverage lapse would be from day 31 until she
went onto dh's insurance.

--
Nikki