adding a newborn to health insurance policy

[newborn]

What is the name of your state? What is the name of your state? Missouri
I recently gave birth. I called our insurance company the day after her birth to request form to add her to our policy. Received the form and signed and dated it 14 days later. mailed it the next day allowing 14 days for insurance company to receive it. Just found out my baby was not added to our policy because the insurance company did not stamp received on it until 5 days after the required date. I know when it was mailed because I mailed it out the same date I mailed their payment and they received that on time. Now they say she must go to medical underwriting (she has health problems that they will exclude now I'm sure) and probably will not pay for any of the baby's hospital stay or the tests that were run on her. I have submitted a grievance letter which I'm sure will do no good. Can I do anything about this matter legally?

 

[cbg]

The problem is, you know when you mailed it. You do NOT know when they received it. Unless you mailed it in the same envelope as the payment, there is no guarantee that it was delivered on the same day.

I once sent out some letters to my siblings regarding some family business. I live in Massachusetts. I mailed all three letters on the same day; one went to Arizona, one went to Florida; the other stayed in MA. When I'd gotten responses from my brother in Arizona and my sister in Florida, but heard nothing from my brother only an hour away, I called him. He hadn't even gotten the letter yet. It took two weeks for him to get it; the others, going thousands of miles, took only a couple of days. You CANNOT prove that they received it when you think they did.

 

[lkc15507]

Can you name the insurer and / or type of plan you are covered under? You mention that your infant has health problems. When was she dismissed from the hospital? IE, did she require hospitalization (did you as well) beyond the norms (2 days vaginal birth, 4 days caesarean birth)? Was the pregnancy / birth precertified with the insurer's utilization review department? These may all be avenues of proving your attempt to enroll the child timely. I would also hope that any insurer would have a record of your call requesting the enrollment form. Do not dismiss the avenue of filing an appeal as you have done--it may certainly be successful. Gather every bit of evidence you may have to support when you mailed the enrollment and to whom. Utilize all time you have for an appeal and a secondary appeal to prepare a well thought out defense. Ask the insurer to produce the post-marked envelope. (Post-dating with a "received" stamp is just too easy.) If things are as you say, being only 5 days late (as evidenced only by the insurer's "received" stamp), I think you are in a defensible position if you follow your plan's rules for appeals etc. Please post any info you have regarding the plan you / child is / would be covered under.

PS, I am from MO also, lets determine if you / your child could be covered under any automatic enrollment laws.

lkc15507

 

[ndb3]

May not help with ongoing coverage, but may help with initial hospital stay

Might be of benefit to read my post to the following thread.

https://forum.freeadvice.com/showthread.php?t=188613