double coverage for mom, who pays for babies?

[missfroggy]

What is the name of your state (only U.S. law)? California

So I have a primary insurance with Healthnet PPO and a secondary from my spouse also with Healthnet but it is an HMO. I have been using the HMO during the entire pregnancy and was expecting to use it for the delivery. So a few questions?

1) If my PPO is 90/10 and I get a bill for my delivery for $17,000 should my HMO be picking up the 10% charge (after the deductible)? I got a charge for $250 deductible and $1250 for my responsibility. I thought the HMO would cover the $1,250. Is there going to be a different rule if my double coverage is both out of the same company/school district or Healthnet insurance?

2) Do my newborns (I had twins) follow the birthday rule and should they be covered under my husband's HMO(his birthday is May and mine is July)? They were in the NICU for 2 weeks each and accrued over $100,000 in bills and I am hoping that they will try not to use my PPO because 10% is much higher than the HMO bill of $250 each. Both babies were put on my husbands HMO within the 30 days. I am discontinuing the PPO insurance.

Thank you for any assistance

[ecmst12]

You need to ask the HMO these questions, it depends on their COB rules. Have all claims been submitted to your secondary coverage? That would be a start. You can't CHOOSE which insurance to use, you have to use YOUR insurance first and your husband's second.

Did you add the babies to both your and your husbands insurance? If so, then your husbands should be primary and yours secondary and yours will probably not pay anything.

You can't discontinue your coverage on you or the babies (if they were added) unless you leave that job or at open enrollment.

[cbg]

I will also add that NOTHING in the law requires a secondary carrier to pick up the full balance. It depends entirely on their Coordination of Benefits policies.

In general, unless the secondary coverage (and ecmst12 is correct - you do not get to choose which policy is primary and which is secondary) has significantly better benefits than the primary policy, dual coverage is a waste of money.

[missfroggy]

ecmst12

I quit my job so I will not be keeping my PPO insurance. The family is all keeping my secondary insurance through my husband, which is an HMO. So, does the birthday rule apply in my case....because my hospital said that it has to go under my insurance (but that doesnt follow the birthday rule).

[ecmst12]

YOUR charges get billed to your insurance first. The baby's will get billed to dad's insurance first. Confirm that with dad's carrier of course.