Double coverage turn into a nightmare

[johnhips]

What is the name of your state? California

My wife delivered our second baby January 2007 under Blue Cross approved hospital. My wife works for Kaiser but was on disability from Novemeber of 2006. Earlier in the year we decided to cover her under my insurance plan in case her Kaiser medical benefits expires.

She delivered our baby January 15, 2007 and at that same day they discovered something not right in my baby's heart. Unfortunately they don't have all the necessary equipments to do all the test so they brought him to Children's Hospital in Oakland. Our baby stayed there for 2 days and were very glad all the tests were negative.

The nightmare started when we received a bill from Children's Hospital and at the same time Kaiser got the bill too. They told us since my wife is older than me (only 1 month), they have to bill Kaiser based on this birthday RULE. In the end, Kaiser denied the claim because this wasn't an emergency but a post stabilization care. Kaiser told us we have to call them as soon as they transferred our baby to Children's Hospital.

At that time, we never thought of calling Kaiser since me and my wife were not at all aware of this birthdate rule. I thought Blue Cross will just take care all of the hospital bills.

Now, I would like to know what are our options. My son wasn't officially added into my insurance coverage until 15 days after he was born. So there's also little chance they will pay this bill. Please help cuz I can't pay $16K of hospital bills

[cbg]

This is one reason I recommend never going for double coverage unless the secondary plan is significantly better than the primary plan.

Unfortunately, your assumptions that BCBS would cover everything without checking beforehand may end up costing you big time. Which plan is primary and which is secondary is contractually set, and the majority of plans do use the birthday rule. This is legal.

If Kaiser is the primary plan (and based on the facts presented it would be) then all bills have to be submitted to them first. There's no way around that. However, the fact that the baby was not added to the BCBS plan until he was fifteen days old does not mean that coverage starts on that day. As long as he was added to the plan within 30 days of his birth, coverage should start on the day of his birth.

What I would do at this point is send all bills, along with a copy of anything that Kaiser did pay and any denial notices they have sent, to BCBS. I'm not promising that they'll pay everything; I'm not promising that they'll pay anything at all. And it's VERY important that you include the denials and payment notices from Kaiser - it's unlikely BCBS will pay anything without those. But it certainly can't do you any harm to try.