newborn pays a deductible?

[averad]

What else are they charging him for--that he has to pay a deductible?

Yes he has his own deductible and I clarified that in my previous post (If I have not answered you question please reclarify what you are asking as i have answered your deductible and benifit question). The baby and yourself are 2 separate people/members. You are being charged a deductible on the first covered major medical charge for your child after the delivery.

If you still think the deductible should not apply please remember that the newborn child is a separate member on the policy imminently after delivery (Services for circumcision, pediatric and other medical claims would be processed under the newborn and applied to deductible unless otherwise noted. This is again because the baby is his/her own human beeing and a seperate member on the policy following the delivery).

 

[jbmb1012]

I understand he is his own person, has his own deductible. I understand that upon his arrival he became his own person. I was surprised his birth would require a deductible being paid---for HIM. Sick visits and other medical attention do require a deductible being met for other things...but BECAUSE his care and hospital stay--as I read it--for mom and newborn is covered under the condition of "pregnancy"--and that was why we were there...I do not understand why HE has to have a deductible to be met. All care and stay was related to the pregnancy. And he was not pregnant--I was. And it says for participant or spouse to pay deductible. And to me, it is like having us pay twice for the same condition. Just like if family members were injured in the same accident. Albeit, not an accident...but we were in there for the same thing. As far as I see it, this plan is not clear enough---or hidden. No where does it say that upon birth of a child--that newborn must pay a deductible. The only thing it says is that we have 30 days to get our newborn on our plan. It might be easy peasy to explain on your end---but HR and Insurance are having a hard time--they say we have a deductible but cannot explain to us why--because it is not clear to them.

 

[averad]

I understand he is his own person, has his own deductible. I understand that upon his arrival he became his own person. I was surprised his birth would require a deductible being paid---for HIM. Sick visits and other medical attention do require a deductible being met for other things...but BECAUSE his care and hospital stay--as I read it--for mom and newborn is covered under the condition of "pregnancy"--and that was why we were there...I do not understand why HE has to have a deductible to be met. All care and stay was related to the pregnancy. And he was not pregnant--I was. And it says for participant or spouse to pay deductible. And to me, it is like having us pay twice for the same condition. Just like if family members were injured in the same accident. Albeit, not an accident...but we were in there for the same thing. As far as I see it, this plan is not clear enough---or hidden. No where does it say that upon birth of a child--that newborn must pay a deductible. The only thing it says is that we have 30 days to get our newborn on our plan. It might be easy peasy to explain on your end---but HR and Insurance are having a hard time--they say we have a deductible but cannot explain to us why--because it is not clear to them.

I have answered all of your questions in my previous posts as clearly as they can be explained.

Your benefits do not state you only pay one deductible per diagnosis & the accident portion of your benefits has nothing to do with your situation (You are comparing apples to oranges).

You state you were pregnant not the child but, you also stated that you are being charged a deductible on the circumcision & newborn care. Those services are separate from the delivery and paid under the child (You were not the one receiving a circumcision).

The new born care is listed under pregnancy to put it somewhere in the book. It is not listed to state all services below are bundled under the mother.

 

[jbmb1012]

No, I am reading everything that is covered under PREGNANCY. The first statement says---Participant or Spouse. Meaning--deductible met for participant or spouse (whoever is pg) then this is covered 100% after deductible. Not Participant, Spouse and Newborn. Then under that it says---Prenatal visits covered. And Maternity Stay is covered for mother AND child. As well as NEWBORN CARE in the hospital---which includes, well care, in doctor visits, circ, nursery...etc. To me, that is very clear. I paid the deductible--I am the spouse--and my child and I were covered. There is nothing else for newborn care. Nothing separate. Whatever, I appreciate your help. I do feel that you are clear--but you are not here reading my plan, and understanding all little things we are going thru--it makes no sense to keep hashing it. Cause if it were as simple as you feel---then it would be resolved---not 6 months later. And my husband works for a good and well known company affiliated with the media. His boss is one of the most influencial people in the world. I don't have a lot of faith in the CS people at his insurance---but I think we are all educated enough to figure it out. I think we found a gray area. I will let you know how it turns out.

 

[AHA]

Just FYI:

I have dealt with several HRs and insurance companies about the benefits, and anyone who actually believes that everyone knows everything about what they are supposed to know are fooling themselves. Some didnt know squat and would just say "call the insurance company" or "call your HR department". Others knew what they were talking about.
So let's not go crazy and think that all HRs, insurance companies and customer services are 100% what they should be (hell, if I can find someone that speaks english, I'm feeling lucky).
There are "bad seeds" in every profession and in every part of the working world, so there is no way for us to know if OP's HR and insurance company were good or bad, because there are plenty of both.

 

[jbmb1012]

Right. And if I would have just listened to what they Insurance company was telling me--about the separate incident with my 2nd child---we would have been $$$$$ in the whole. $200 I already paid out, and then I would have been dragging my kids to the local clinic, standing in line...to get their immunizations. Instead, I questioned it. 4-5 times. They were wrong. With this matter---the pregnancy clause is clear to me---what is covered, what is not---after my deductible was met. It is about the ONLY thing that is clear to me. When they say we owe the deductible---and I ask to them tell me what page they are on---they either can't say, or refer me to the most VAGUE statement in the plan. It's a gray area.

 

[averad]

I hope your credit report doesnt get ruined over a $250 deductible and over 6 months of time.

File an appeal with your insurance carrier and when you receive a wrien responce back (with the same answer) take it and file a complaint with http://www.idfpr.com/DOI/Default2.asp. When you get a writen responce from the DOI you should finally have a answer you can be sure of.

Please post the end solution

 

[averad]

Who is the Insurance Carrier (If I may ask).

If the claim was in 2005 and a deductible was taken on the child. Even if they decide that you wouldn_t owe the deductible on the newborn services you would still owe the deductible on another medical claim. So you_re going to end up paying the deductible it_s just on what claim. However this comment is based on my limited knowledge of your policy (claims,history etc).

 

[jbmb1012]

Thanks--I was just looking on that website a few days ago. I was told if I file a complaint, at the very least it would be taken out of collections until a resolution. In the meantime, I called the hospital for another itemized bill--so that I can send this to them. I will give another few days. If that is not true, then we willl probably pay it just to not tarnish our credit.

Professional Benefit Administrators is the insurance.

My child was born in November. The new calendar year started in January. There were no medical issues in that time. For 2006, my children have been sick, myself and husband included...we are paying off our deductible.

One last thing, if we owe that deductible, so be it. Just show me where, what page...etc...it explains this in our coverage. I see plain as day where medical conditions, sick visits, lab work...etc...require a deductiblie being met, the 100% coverage. But, he was being born, and his "newborn care" and everything around that--was covered. Also, HR told us TWICE we did not have to pay it--which is why it's been 6 months. Twice now, we thought it was settled.