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  1. #1
    newborntrouble is offline Junior Member
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    Is an infant covered under the mother's insurance while in the hospital?

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

    I had a baby with no complications in November under the insurance of Blue Options of Blue Cross Blue Shield of Florida. I checked out 24 hours after delivery and the insurance company covered my expenses and I paid my $300 per day copay. In January I received a bill from the hospital with my baby's name on it for $1,700 for inpaitent. My insurance company says they do not cover any expenses from a newborn after birth if they are not added to the mother's insurance. I did not add him onto my insurance because it was expensive, instead he has his own isurance through a different company that started in January. I thought it was a federal law that the baby was covered under the mother's insurance for up to 48 hours after delivery. Am I correct? What should I do?
  2. #2
    ecmst12 is offline Senior Member
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    Baby is not covered under mom's insurance. Mom has 30 days to add baby to plan to have coverage be retroactive to date of birth. You missed the 30 day window so he had no coverage until his new plan started. Bet it would have been cheaper to add him.
  3. #3
    newborntrouble is offline Junior Member
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    What about Florida Statutes?

    O.K. What about Florida Statutes 627.6574, which clearly states: "Any group, blanket, or franchise policy of health insurance that privides coverage, benefits, or services for maternity or newborn care MUST provide coverage for postdelivery care for a mother AND her newborn infant."
  4. #4
    ecmst12 is offline Senior Member
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    State laws do not apply to self funded plans, which almost all employer-sponsored plans are these days.
  5. #5
    momm2500 is offline Member
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    you indicated that child has different insurance in january, have you contacted them to cover the child?
  6. #6
    cbg
    cbg is offline Senior Member
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    Quote Originally Posted by ecmst12 View Post
    State laws do not apply to self funded plans, which almost all employer-sponsored plans are these days.
    I do not disagree with the first statement, but I do disagree that "almost all" employer sponsored plans are self-funded these days. I know of quite a few small employers that are still fully funded. I will agree that many mid sized companies and most large companies are self-funded, but self-funding is not cost effective for most small companies unless they have a very low stop loss, in which case the point of self-funding is lost.
  7. #7
    newborntrouble is offline Junior Member
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    Is an infant covered...

    Why does it matter if it is a self-funded plan or not? 627.6574 states: "Any group, blanket, or franchise policy of health insurance that provides coverage, benefits, or services"? My insurance provides maternity coverage for me, so it should also include my newborn. Also, in the BlueCross Blue Shield of Florida's Summary of Plan Description they refer to statute 627.6574 saying: "The PPO Plan will only cover the initial newborn assessment [B]as mandated by s.627.6574, Florida Statutes[B]." So, they must be required to follow that law. I had BlueCross BlueShield of Florida for the birth of my first child three years ago. At that time they covered the baby's hospital expenses. My insurance was an HMO at the time and now it is a PPO. Could this have anything to do with why newborns are not covered?
  8. #8
    ecmst12 is offline Senior Member
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    I have no idea WHY the law is the way it is. I told you what the law says. Self funded plans are only subject to FEDERAL, not state, laws. They may CHOOSE to follow state laws but they are not required to.

    When you had your older kids, did you add them to your plan within 30 days?
  9. #9
    newborntrouble is offline Junior Member
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    OK, so the state law does not apply. Wouldn't the federal Newborns' Health Protection Act apply in this case? My fist child was not added to my insurance within thirty days, but all costs were covered.
  10. #10
    ecmst12 is offline Senior Member
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    Maybe your old plan was just written differently then your current plan.
  11. #11
    lkc15507 is offline Member
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    I have a couple of questions. Why was your baby not discharged at the same time you were? When was your baby discharged? IE, How many days inpatient for baby after your discharge and with what if any diagnosis? I am unclear as to all the events. But, if baby went home in 48 hours, I agree with you that there is / could be a problem regarless federal / state law applicable. What I mean is, Federal does trump state law. I am in your corner at this point that a well born, newborn has 48 hours under your plan. From what time period of service does the out of pocket arise? Federal law does allow 48 hours--for mom and baby--, so for a health plan to assume that mom being discharged 24 hours earlier indicates a problem / diagnosis for baby is erroneous. But, what is missing for me is whether or not there really was a problem / separate admission for baby. (Emphasis goes back to "well born".)
    Last edited by lkc15507; 02-10-2009 at 10:38 PM.
  12. #12
    lkc15507 is offline Member
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    And, just to clarify, that 48 hours starts with delivery, not mom's admission.
  13. #13
    ecmst12 is offline Senior Member
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    The Newborn Health Protection Act that you refer to does not have anything to do with whether mom's or baby's plan pays for baby's hospital stay. The act has to do with the length of the hospital stay only. Prior to this law, there was a problem with insurance plans mandating "drive through deliveries" and not allowing the MOTHER sufficient recovery time after childbirth. The law states that when maternity coverage is provided, the length of the hospital stay cannot be limited to less then 48 hours after a natural birth or 96 hours after c-section. It does NOT say that if mom's stay is covered, baby's must be also. It does NOT dictate which plan is to cover the baby's charges. It ONLY sets the minimum hospital stay that must be approved WHEN COVERAGE IS AVAILABLE for mom and baby.

    It is uncommon for baby's charges to be paid under mom's plan. It is MOST common for baby's charges to be paid by baby's own plan, and another federal law states that with employer-sponsored group plans, the baby MUST be added within 30 days of birth in order for coverage to be available as of the date of birth. And if baby is NOT added in that time frame, he won't be ABLE to be added until the next open enrollment period.

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