New born baby medical expenses coverage within 30 days of birth

[Neeraja]

What is the name of your state?
California

My husband and me have an seperate individual medical coverages. My husband enrolled me in a Individual PPO Health Plan that has maternity Coverage with Deductable dollars every Calender year. We have a new born baby this August 2007, by the time of birth i met the maximum deductable dollars for my individual PPO plan. My Health Insruance people told me that first 30 days my health plan is going to cover my new born baby without enrolling her name to my plan, in order to have the coverage from 31st day i have to enroll baby name in my insurance which i didn't. After 20 days of baby birth I enrolled my new born baby to a different insurance (My Husband's) as the premiums will be less if i choose that route.



Question is

1. Do i need to pay seperate deductable for my new born baby medical expenses occured during the first 20 days after the birth (Baby had complications during birth). By the time of birth i already covered my MAX deductable for the plan. My health insruance people says i have to pay a seperate deductable which is equiavalent to my deductable.

what my arguments with them was those expenses were below 30 days of the birth and that too within birth month. Also all the expenses were during the birth of the baby.
Please Advice

[moburkes]

Originally Posted by Neeraja

What is the name of your state?
California

My husband and me have an seperate individual medical coverages. My husband enrolled me in a Individual PPO Health Plan that has maternity Coverage with Deductable dollars every Calender year. We have a new born baby this August 2007, by the time of birth i met the maximum deductable dollars for my individual PPO plan. My Health Insruance people told me that first 30 days my health plan is going to cover my new born baby without enrolling her name to my plan, in order to have the coverage from 31st day i have to enroll baby name in my insurance which i didn't. After 20 days of baby birth I enrolled my new born baby to a different insurance (My Husband's) as the premiums will be less if i choose that route.



Question is

1. Do i need to pay seperate deductable for my new born baby medical expenses occured during the first 20 days after the birth (Baby had complications during birth). By the time of birth i already covered my MAX deductable for the plan. My health insruance people says i have to pay a seperate deductable which is equiavalent to my deductable.

what my arguments with them was those expenses were below 30 days of the birth and that too within birth month. Also all the expenses were during the birth of the baby.
Please Advice

Yes, each person is required to pay a separate deductible. However, you may want to relook at YOUR plan. Babies are only covered if you add them within 30 days, and it appears that you didn't do that, nor were there complications with the delivery.

[cbg]

The answer to your question is plan-specific, not law. Whether or not you need to pay a separate deductible for your baby's charges during that 30 days should be covered in your policy. If you can't find it, you will need to contact your carrier. The representative who sold you the plan should also be able to answer.

In my state, BTW, babies are covered for the first 30 days whether you subsequently add them to the plan or not.

[moburkes]

Originally Posted by cbg

The answer to your question is plan-specific, not law. Whether or not you need to pay a separate deductible for your baby's charges during that 30 days should be covered in your policy. If you can't find it, you will need to contact your carrier. The representative who sold you the plan should also be able to answer.

In my state, BTW, babies are covered for the first 30 days whether you subsequently add them to the plan or not.

Good to know on the newborn coverage. I didn't find anything that mandated that in CA, but I certainly didn't check everywhere. Thanks.

[ecmst12]

Wouldn't the husband's plan have covered the baby back to the date of birth (possibly excluding the initial hospital stay)?

[cbg]

I was wondering that too but the poster didn't ask that and at the hour of the morning I was posting, I didn't bother to volunteer.

[Neeraja]

Thanks for your valuable responses from the senior members. Can you also respond to the below concern raised by one of the senior member?

Wouldn't the husband's plan have covered the baby back to the date of birth (possibly excluding the initial hospital stay)?


1. 99.9% of Baby's Mecical Expenses were from the Initial Hospital Stay. (July 20-22)
2. Only 2 times Well baby check doctor visits after the Initial hospital Stay. (Before July 30th)
3.I enrolled the baby in to my husband's plan which is effective August 1st, 2007.
4. The above mentioned hospital stay and visits were before august 1st, so i don't think my husband plan covers my baby expenses that occured before august 1st.

[moburkes]

Originally Posted by Neeraja

Thanks for your valuable responses from the senior members. Can you also respond to the below concern raised by one of the senior member?

Wouldn't the husband's plan have covered the baby back to the date of birth (possibly excluding the initial hospital stay)?


1. 99.9% of Baby's Mecical Expenses were from the Initial Hospital Stay. (July 20-22)
2. Only 2 times Well baby check doctor visits after the Initial hospital Stay. (Before July 30th)
3.I enrolled the baby in to my husband's plan which is effective August 1st, 2007.
4. The above mentioned hospital stay and visits were before august 1st, so i don't think my husband plan covers my baby expenses that occured before august 1st.

Do you have a copy of his insurance plan? All of your questions will be answered there.