Adding a newborn to insurance

[chixbaby27]

What is the name of your state? Georgia

I gave birth to my 3rd child on January 26th. On January 29th, we contacted the insurance company and told them about the baby. We were told that they couldn't do anything about it until they got the information about her birth from the hospital, and to call back in a few days. My husband called back, and was told that they had sent a letter to us in the mail. I received a form wanting to know if we had any other insurance...we did not, I filled it out and sent it back via fax. My husband called over and over and over throughout the next 31 days to see if she was added and never got a straight answer. Once the 31 days passed (that we have in order to add a new baby), we were told that we had not submitted a form to have her added. In all the phone calls we made asking how to get her added, no one ever told us about this form.

So now I am facing lots and lots of medical bills and being told there is nothing we can do until open enrollment, which isn't for many more months.

Does this sound right, or is there anything we might can do? It's very frustrating, as all we did with our other 2 kids is call and they added them on right away. We expected the same this time, instead we were given the run around and not helped at all.

Thanks in advance for any help you can give me!

~Juli in GA

[Zigner]

Is the insurance through your employer? What did your employer say?

[ecmst12]

If you can prove that you submitted the correct form within the 31 days, they *might* be able to straighten it out, but the time frame is very strict and it's possible that they won't be able to add the baby even if it was their error.

[chixbaby27]

Yes, the insurance is through my employer. They said "well, you didn't request the form after the baby was born." I informed them that I didn't KNOW to request it...we asked the insurance company repeatedly and they wouldn't tell us what to do.

I did fill out the form they sent me, but it turns out they sent me the wrong thing and what I filled out didn't matter.

[ecmst12]

You should have been contacting your HR department in addition to your insurance company, they could have helped you. You've done this before, you should have known what form you needed and where to get it from. At this point there's nothing anyone can do until open enrollment.

[moburkes]

Originally Posted by chixbaby27

Yes, the insurance is through my employer. They said "well, you didn't request the form after the baby was born." I informed them that I didn't KNOW to request it...we asked the insurance company repeatedly and they wouldn't tell us what to do.

I did fill out the form they sent me, but it turns out they sent me the wrong thing and what I filled out didn't matter.

What additional $ are you out? Unless the baby was sick, the baby should have only been seen by the doctor once since the birth.

[Ohiogal]

Originally Posted by moburkes

What additional $ are you out? Unless the baby was sick, the baby should have only been seen by the doctor once since the birth.

You are forgetting the costs of the baby's hospitalization after birth. the child has his/her own medical costs for the time he/she is in the hospital that can easily run into hundreds of dollars if not more. Oh and my baby has seen the doctor at one month, two months and is scheduled for a four month visit.

[moburkes]

Originally Posted by Ohiogal

You are forgetting the costs of the baby's hospitalization after birth. the child has his/her own medical costs for the time he/she is in the hospital that can easily run into hundreds of dollars if not more. Oh and my baby has seen the doctor at one month, two months and is scheduled for a four month visit.

That's covered by mom's insurance.

You're right about the rest. I was thinking that this person posted just after the time period has passed, but when I look back, it has been several months since the birth.

[chixbaby27]

You're right ~ I HAVE done this before. And with my other two children, we contacted the insurance company the week after they were born, the hospital sent in a notice of live birth to them, and they were automatically added. There were no forms to fill out and send in when we had them.

[ecmst12]

Mom's insurance does not always cover the nursery charges and definitely doesn't cover the well baby checkups. Sometimes mom's insurance only covers the nursery charges if the baby is added within the 30 days after birth.

[moburkes]

Newborns' & Mothers' Protections (Newborns' Act)

The Newborns' and Mothers' Health Protection Act (Newborns' Act) includes important protections for mothers and their newborn children with regard to the length of the hospital stay following childbirth. The Newborns' Act requires that group health plans that offer maternity coverage pay for at least a 48-hour hospital stay following childbirth (96-hour stay in the case of Cesarean section).

A plan, insurance company or HMO cannot deny you or your newborn child coverage for a 48-hour stay (or 96-hour stay) because the plan claims that you, or your attending provider, have failed to show that the 48-hour stay (or 96-hour stay) is medically necessary.

*****************

I know that it doesn't cover well baby care. Like I said, I didn't realize when I posted, that the baby was several months old, and that she was referring to those visits.

[ecmst12]

Are you sure that law doesn't just require coverage for MOM'S stay? I believe that law was enacted because of the "drive through deliveries" that were happening in some places, where insurance was only covering for mom to have one night in the hospital after a normal delivery (or possibly no inpatient stay at all).

Besides...

A plan, insurance company or HMO cannot deny you or your newborn child coverage for a 48-hour stay (or 96-hour stay) because the plan claims that you, or your attending provider, have failed to show that the 48-hour stay (or 96-hour stay) is medically necessary.

That doesn't say anything about being unable to deny coverage because the patient is not eligible for benefits, only that it can't be denied for medical necessity. If the plan requires the newborn to be added within the 30 days in order for the nursery care to be covered, and the baby was NOT added, then it's legal for them to deny coverage because the patient was not enrolled.

[moburkes]

A plan, insurance company or HMO cannot deny you or your newborn child coverage for a 48-hour stay (or 96-hour stay) because the plan claims that you, or your attending provider, have failed to show that the 48-hour stay (or 96-hour stay) is medically necessary.

Your newborn CANNOT be denied coverage because the insurance company wants proof that it is medically necessary. Its a requirement. I'll see if I can find it in better terms.

[moburkes]

Is this a better explanation?

The Newborns’ Act and its regulations provide that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay that is connected to childbirth to less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section. However, the attending provider (who may be a physician or nurse midwife) may decide, after consulting with the mother, to discharge the mother or newborn child earlier.

[ecmst12]

Originally Posted by moburkes

Your newborn CANNOT be denied coverage because the insurance company wants proof that it is medically necessary.

But they CAN be denied coverage if they are not eligible for benefits. If no coverage exists and the procedures to add the baby to the policy are not followed, then payment CAN be denied.