A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth? UPDATE with info from INS. may be helpful to others

not sure if this will make sense, but here goes.


once I give birth, I am planning to go on dh's firms family plan with the baby covered there as well.

this plan is "only" going to cost us $3k a year max, vs. the $7200 the family plan with my insurance will cost us.

so, here is my dilemma.

I am currently with a PPO that covers EVERYTHING having to do with my pregnancy care and hospital stay.

I am going into a HIGH DEDUCTIBLE plan with my husband, when we sign the baby up.

I am a bit confused as to what is covered for the baby's birth under my personal insurance vs. when the baby's own health insurance is supposed to kick in.

I DO NOT want to be hit with an insane hosptial bill for the baby's care. I DO NOT want there to be any lapse in coverage.

from my ins co's website:

WE COVER ROUTINE NURSERY CARE FOR THE NEWBORN CHILD DURING THE COVERED PORTION OF THE MOTHERS MATERNITY STAY. WE WILL COVER OTHER CARE OF AN INFANT WHO COVERS NON ROUTINE TREATMENT ONLY IF WE COVER THE INFANT UNDER A SELF AND FAMILY ENROLLMENT.

so I am kind of torn. I want the baby covered right away. but I don't want to lose MY benefits through my health plan before I am discharged from the hospital.

I also don't want, if my CURRENT Ins policy is responsible for these total regular hospital stay under my SELF coverage, to tell me I have to bill the babies insurance (ie...pay cash since my DD will be so high.)

if anyone is able to follow this, great. if anyone has any experience, even better. if any of you work of GHI...please tell me what this policy really means.

TIA

UPDATE:

I called MY personal (SELF) insurer, GHI. I have a hi option POS plan within the FEHBP. (just wanted to add that since there are so many different kinds)

the baby will be covered by MY SELF plan for 5 days after the birth. even if I decide NOT to enroll the baby in the GHI SELF and FAMILY plan, they will pay for all charges for that time period. I will still have to fill out paperwork and give GHI the baby's info (name, dob etc) but I will not be charged a premium for the family plan and the baby will be covered.

whatever we decide to do after that time period is on us.

they also offered to help me go over the pros and cons of the two plans (GHI happens to now be part of EmblemHealth, which is what my dh's plan is) so we can decide if the cost benefits will really be there for us.

I feel 100 million times better now.

thanks for your help ladies.

Message edited 8/6/2009 3:09:59 PM.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

I would wait until after you are out of the hospital, then change insurance. You should have up to 30 days to add the baby to an insurance plan.
I'd add the baby to your husband's plan, and then after all your hospital bills are taken care of, switch yourself. Does your DH's plan allow you to be added when it is not open enrollment?

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

I think you have 30 days to sign up the baby and that is retroactive to the day of birth. That would lead me to believe that you will owe the deductible if you sign the baby up on your DH's plan. Are you sure there's a deductible for newborn coverage under your DH's plan????

I would call both insurance companies to make sure you get the correct coverage.

ETA when is his open enrollment? January? Maybe stay on your insurance until his open enrollment period since your insurance is better for the birth.

Message edited 8/6/2009 2:42:20 PM.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Message edited 8/6/2009 2:43:59 PM.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

DS was put under my DH's insurance. However, he was automatically covered under my insurance for 30 days after he was born. All his hospital care was paid by my insurance and his first 2 peds visits were paid out by my insurance.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth?

Yes, I did. I'm pretty sure that everything for me was billed by the hospital to the old (my) insurance, everything for dd was billed to the new insurance (DH's). We had absolutely no problems with the hospital billing department, and definitely remember them calling me to make sure they were submitting the claims to the correct companies before they did it. Also no problems with the pediatrician, who even held off on submitting claims until after Sarah's 2nd appointment and we got the new insurance cards in the mail.

However, my OB's fees turned into a COMPLETE nightmare. When I went in for my 6 week checkup at my OB/GYN's office I gave them my new insurance, assuming that they had already billed everything that was in the past and that they understood this was for everything going forward. However, they had not submitted their bills for the pregnancy and delivery and billed the new insurance for everything. The claim was denied since most of the fees were from before the coverage started (dd's birthdate). I kept telling the office they were billing the wrong one, they kept re-submitting to the new one. This went on for about 9 months.

Ordinarily that would get ironed out eventually. I was unlucky enough that in the midst of all this happening, the company I used to work for changed insurance companies and told them not to pay out on claims sent in after a certain date. Since I was not a current employee I was not notified that this was happening and was not able to get my OB's office to get the bills straight in time, so we were on the hook for his fees for the pregnancy and delivery. I called the old insurance and tried to get them to cover it since I'd paid into the plan and all the bills were from back when I was covered, but the company had no money left in the account at the insurance company and they wouldn't do anything for me. It still pizzes me off to think about 4.5 years later.

So my advice is to be a polite PITA to your OB's billing person to make sure they get it all straight, and in a timely fashion.

Oh, and births are one of the life events that you are allowed to change your insurance at a time other than open enrollment.

Message edited 8/6/2009 3:09:17 PM.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth? UPDATE with info from INS. may be helpful to othe

UPDATE:

I called MY personal (SELF) insurer, GHI. I have a hi option POS plan within the FEHBP. (just wanted to add that since there are so many different kinds)

the baby will be covered by MY SELF plan for 5 days after the birth. even if I decide NOT to enroll the baby in the GHI SELF and FAMILY plan, they will pay for all charges for that time period. I will still have to fill out paperwork and give GHI the baby's info (name, dob etc) but I will not be charged a premium for the family plan and the baby will be covered.

whatever we decide to do after that time period is on us.

they also offered to help me go over the pros and cons of the two plans (GHI happens to now be part of EmblemHealth, which is what my dh's plan is) so we can decide if the cost benefits will really be there for us.

I feel 100 million times better now.

thanks for your help ladies.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth? UPDATE with info from INS. may be helpful to othe

Posted by CathyB

It still pizzes me off to think about 4.5 years later.

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth? UPDATE with info from INS. may be helpful to othe

It seems like they answered your questions but make sure to notify them that you had the baby and that the baby is going to be covered under you plan for the x amount of days effective at the babies birth so they pay the bill.

3 years later and I am having this problem. The hospital didn't get paid for DS's stay BUT his first doctors visit at 5 days old and the audiology testing done at the hospital and all the blood tests were paid for, unless that is part of the hospital stay for the newborn. Not to mention I have no idea which insurance paid it since no one has records

Re: A question about health coverage, the birth and subsequent hospital stay, and your baby- did anyone change insurances immediately after the birth? UPDATE with info from INS. may be helpful to othe

I have my own insurance through work. I have DH's as secondary which I got the year before with open enrollment. Abby was covered under my insurance while she was in the hospital including her NICU stay. The day weleft the hospital, she was to be DROPPED from my plan and picked up by DH's plan because he has better coverage and he was also already paying for family coverage so it was pointless for me to do so as well. She wasn't covered under his from the get go because my birthday comes before DH's. I don't see why that makes a difference but apparently it is some kind of marker.

Needless to say, my employer processed the paperwork involved in dropping Abigail, but guess what. My insurance company did not thus creating a nightmare of red tape for months that is still continuing to this day. We get bills upon bills and they have to be resubmitted to DH's company over and over again.

Abby has been "covered" under DH's insurance retroactively since the day she left the hospital but it was a logistical nightmare.

Be very careful and get names of anyone who you speak with on the phone and make copies of everything.

Message edited 8/6/2009 9:07:03 PM.