Help with newborn coverage

[altaira]

What is the name of your state? Mississippi

I'd really appreciate your advice regarding our situation.

I am currently in the state's risk pool due to a pre-existing condition that makes me otherwise uninsurable. My husband and toddler daughter are covered by private individual insurance, as health insurance is not available through his work. The risk pool does not allow any other individuals to be added to my policy.

In January, we called Assurant, my husband's insurer, to tell them we were expecting twins in April. They told us we had a certain number of days after the birth to add them in order to have them covered as of the date of birth.

After the birth, we added the twins within a week or so. Now Assurant is denying the hospital claims for the twins (about $4000 total). The first time we called, they said the twins were covered now, but were not the day they were born. However, MY insurer, BC/BS, told me that Mississippi law states that newborns must be covered if they are added to the policy within 31 days (which they were).

So we called again. This time, Assurant said routine newborn charges aren't covered because there was no maternity rider on the policy. We were never told about such a rider before. And why would we need one if the pregnant one is not even on the policy?

Basically, his insurer is saying my insurance is responsible for the charges, and my insurer says the reverse.

Are we screwed, or do we have any recourse?

Thanks so much in advance for your reply.

[ecmst12]

On the policy that I used to work for, the baby's initial hospital claims were paid under the mom's policy, provided the mom was covered. If the mom was not covered, those bills were usually covered by whatever insurance she did have. Have you discussed the bills with your insurance to see if they are covered as part of your delivery charges?

[Betty]

I would check with your ins. as suggested by ecmst12. The ins. co. I worked for re individual health policies with family coverage we would insure a child after they were 14 days old or the date they were released from the hosp. whichever is later. This date would be the date of issue (effective date) of child's coverage. (This protected the co. in case of a long hosp. stay after birth or a medical problem that developed before they were 14 days old.) -- not too great for the parents though who had to pay the medical bills. However, Il. (there may be other states also) now require that a newborn child be covered from birth (even if they have med. problems) to an individual or gr. pol. that has dependent coverage. They have "free" coverage for 31 days - but child must be officially enrolled within the 31 days of birth & any prem. paid by day 32. If the policy has no dep. coverage, dep. coverage can be requested on the child within 31 days of birth & the prem. must paid to the ins. co. within 31 days of birth. Also, in Il. the birth of a child creates a special enrollment period under HIPAA - you can add spouse as dependent to your gr. ins. also w/o evidence of insurability as long as they are enrolled within 30 days of birth of child. This applies even if spouse was declined for dep. coverage previously. They may not cover on your spouse pre-existing conditions for 12 mos. - depends on other coverage they had & for how long.

[altaira]

No, my insurance cannot cover this, because, as I stated, my coverage is through the state's risk pool. No other person can be added to my policy.

[Betty]

Hi - ecmst12 & I know no dep. can be added to your coverage - we were just thinking maybe the bills would be paid as part of your delivery charges. Betty

[moburkes]

OP, what does your husband's health insurance policy say? Did you ever read it? Apparently they (the company) are giving you accurate information, and it sounds right to me, but I haven't sold enough health insurance to be sure.
Edited to add: Many individual policies do NOT cover maternity services because then people would only purchase the policy when they (or spouse) become pregnant. The rider would have been extremely expensive anyway, so it may have been a "wash" by the time the baby was born and the charges were determined. Oh, if I had a $1 for every time I got a call from someone who didn't have insurance looking for maternity and dental coverage...because they were pregnant or needed work on their teeth.

As far as the law
Under Mississippi law, newborns are automatically covered under the parents_ individual health insurance policy for the first 31 days, if the plan covers dependents. The insurer may require that the parent enroll the child (and pay the premium) within the 31 days in order to continue coverage beyond the 31 days.

Pleas read the book that your husband received when he enrolled himself and your older child in the program. Does it say anything about maternity or adding another dependent?