Newborn Coverage?

[intrwrks]

What is the name of your state?What is the name of your state? Florida

My wife gave birth to our second child and I immediately added him to my insurance plan. My wife is on her own plan through her company. Several months later the Hospital sent us a bill for $989.00 in our son's name. We contacted my insurance company and they said that we should not be billed this amount and said that they would send a letter to the hospital stating this.

A month later we received another bill. I called back our insurance company and asked why the claim has not been paid, since I have been faithfully paying my premiums. The lady with the insurance company told me that the mother has to be on the same insurance as the newborn at the time of the birth or they will not cover the claim. I have never heard of this!? She went on to say that regardless the hospital is under contract with them and can not bill me for this claim. They said that they would call the hospital and correct this problem.

Another couple of weeks go by and now I have received a letter from a debt collector requesting the money. I have called the hospital and they said that they did receive the phone call but have decided to continue to bill me for the claim.

Is their anything that I can do? I have zero legal experience and do not understand why my insurance will not pay a claim when our baby was listed under their insurance from the beginning.

[cbg]

I've been working with employer sponsored group insurance for twenty five years and this is a new one for me, too. The child has to be on the same plan as the mother? Nonsense.

There are a couple of things you need to do. First, you need to go to someone in your HR or Benefits department and make them aware of this. If they agree that the insurance will not cover a newborn unless the mother is on the same policy, ask them to show you this in the insurance SPD and ask them why you were not notified of this when you added the baby to the insurance. They should be helping you with this.

Next, you need to contact the insurance company and tell them you are being "balance billed" and that the hospital has already ignored previous contact.

You may eventually need to contact an attorney, but try these suggestions first.

BTW, if HR actually is able to show you something in the SPD that states this, you will probably end up having to pay the bill.

[jinxgirl]

Never heard of this. Check your insurance policy/handbook. In Illinois the Department of Insurance as well as the local State Representative are excellent "free" resources. Usually a call to the State Representative is very effective and is free to their constituents. If you elect to contact the Department of Insurance for your state you probably should send a letter, copy the hospital and copy the collection agency. In Illinois this stops the collection agency until the dispute is resolved. I would also request in a letter that what you are being told be produced to you as proof (ie: a copy from their policy or book). If they are in fact correct you may want to file a written appeal with your spouse's insurance to add the baby to her plan retroactive due to the misunderstanding (this is sometimes successful and was occassionally where I used to work which was a state agency). Again, this is Illinois and I am speaking as a very recently retired Benefits Administrator. Good Luck!