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  1. #1
    xyzcb1 is offline Junior Member
    Join Date
    Dec 2007
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    Newborn's health care coverage for the first 30/31 days

    What is the name of your state? New York

    I have a question for the newborn health care coverage. I have been told by doctors that newborn is covered by the mother's insurance for her first 30/31 days regardless of future enrollment or not. However, I received a letter yesterday from the hospital said the insurer denied the claim for my newborn for the reason "baby is not active on the time of service". Yet, the claims from her pediatrician were paid. I got puzzled. I called up the health provider trying to resolve it, and the rep said the baby is not coverage for the first 30 days unless she was enrolled into the plan at birth. AT BIRTH ? There is no way we can enroll her at birth, when both baby and mother still in the hospital, and the birth certificate was not even received almost 1 month after the baby was born.

    Since the doctors and the insurer contradicting each other. I want to know who is correct. I have my wife dealing this with her health administrator on the mean time.

    * The baby is currently enrolled with the State. It's cheaper and LESS HASSLE than going through with my wife or my employer's insurance policy.

    Thanks in advance.
    Last edited by xyzcb1; 12-12-2007 at 11:37 AM.
  2. #2
    cbg
    cbg is offline Senior Member
    Join Date
    Nov 2001
    Location
    Massachusetts
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    34,275
    The doctor is wrong. There is a required 48 or 96 (depending on type of birth) hour coverage on the mother's policy for the newborn; if you do not add the child within the next 30 days that coverage is all you get.

    [url]http://www.ins.state.ny.us/ogco2007/rg070618.htm[/url]

    Of course you can enroll her at birth. You don't need a birth certificate to enroll her; all you need is her name and date of birth.

    P.S. At birth does not mean, the first minute or even the first hour after birth. Under Federal law, you have up to 30 days after a "qualifying event" (birth is one) to add a new dependent to your existing policy. As long as you add it within that 30 day window, coverage will be retroactive to the date of the event (in this case, the birth).

    However, that same Federal law says that if you do NOT add the new dependent (in this case, the baby) within that 30 day window, you CANNOT add the dependent at all until the next open enrollment period.

    (The above two paragraphs presume that the policy is under a Section 125 plan; if the parent's portion of the premium is taken out of their paychecks pre-tax or if there is a pre-tax option, it is. Almost all employer sponsored health insurance plans are Section 125 plans these days. If by any chance this is one of the few that is not, then the employer would not be in violation of the law by adding a new dependent more than 30 days after the qualifying event, but they cannot be legally compelled to do so either, unless the insurance plan document SPECIFICALLY outlines a period of longer than 30 days for new enrollments or additions/changes to enrollments.)

    So if you waited until more than 30 days after the birth to add the baby to the policy, you are out of luck until the next open enrollment period, whenever that might be.
  3. #3
    xyzcb1 is offline Junior Member
    Join Date
    Dec 2007
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    3
    Thanks for the reply. I need to call up my wife health admin to straighten this up. The claim that was denied was for the first 48 hours. I have also made the call to the hospital and asked if this is a common practice for insurer to denied the first 48 hours, and out of my believe, they said YES.

    I cannot believe why the state or any government agency put a stop to these mal-practice.
  4. #4
    xyzcb1 is offline Junior Member
    Join Date
    Dec 2007
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    More update. My wife called up the insurance company, and she said the claim for the pediatrician after discharged from the hospital were also denied.
  5. #5
    ecmst12 is offline Senior Member
    Join Date
    Feb 2006
    Location
    Philadelphia, PA
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    35,506
    Usually all that will be covered under mom's plan is the initial hospital stay. Once the baby is discharged, that's it unless the baby is enrolled within the 30 day window as required.

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