Insurance Help, PLS!

maze_bright

Long story short, I'm very, very worried that my 5 week old LO is not covered by my company's insurance because of something I did wrong inadvertently. My company has Cofinity and I work for a Christian non-profit, if that matters. Here's the skinny. If you can give me ANY insight, please do.

When my LO was two weeks old I had to get a prescription for her, so I called my insurance department and talked to my normal insurance person. She said she was adding my daughter to our policy but that I still had some paperwork I needed to fill out. She advised that I wait till the end of the day to pick up the meds so that the insurance would have time to kick in and cover it. I did, and the meds were covered.

The paperwork I needed to fill out asked for her SSN, which I didn't know at the time. I just got the card in the mail the day before Thanksgiving. I was waiting to fill out the paperwork until got the card. When I tried to fill it out, I noticed it said I had 30 days from her birth to turn it in, so I looked at my latest Explanation of Benefits. Sure enough, NONE of the claims I had for her have been covered, and they already amount to several thousand dollars.

I sent my insurance lady an email explaining all of this and asking for any help at all.

I'm wondering if this is entirely up to my company at this point and if I even have a leg to stand on. I was definitely under the impression from that phone call that my daughter was covered! And I was going to send in the paperwork as soon as I got her SSN-- I wasn't just being lazy about it. I'm so, so worried that she won't be covered. If it's just up to my company, I think they'll retroactively cover us. I just don't understand insurance enough for all of this. 

If anyone has experience with the insurance industry or HR, please give me your thoughts about this.

Thanks so much! 

NewMomAlyssa

I don't think they'd deny claims because you forgot her ssn.

 My daughter was covered for the first 30 days under MY policy, without being added. Yours should be covered under yours as well, esp since they said to turn the paperwork in 30 days after her birth (most baby ins policies dont kick in until they are 30 days old).  If this is true your policy should be covering it not your baby's.

Call on Monday and get someone on the phone, I'm sure they can work it out. Good luck!

mariep26

At my company you must add a child within 31 days of birth and generally you will not have the SSN at that time.  I can see in our online system whether she was added or not so I could double check.  If you do not add the child then they are not covered until the next open enrollment.

It sounds like she should be covered if the person at your company added her correctly (and if she was covered for the meds). If not, be sure you are completely honest about the details (who you talked to, when, and what was said) because it could be considered fraud if you are not.  BTW, I don't think you would be dishonest but I know that could be grounds for termination at alot of companies.

MrsTechie

I worked for a medical insurance company for a while. I underwrote policies, reviewed medical records, did telephone interviews and handled a few claims.

My advice to you is not to get in a panic yet. The first thing I would find out is- when is your child covered? Most policies cover the child when they are born (the initial hospital stuff) and a few days beyond that without needing to update your policy.

My next bit of advice is to check when you made the call about the prescription and became under the impression that your LO was covered. When did that happen? If this was say, 15 days after her birth then in the event that your insurance company becomes picky I would point out that you didn't even know about the paperwork until 15 days ago. So, how can you turn in paperwork you aren't aware of? Especially paperwork that the ins. company gives you 30 days to complete.

Finally, remember that your claims adjuster is going to be human- they're going to understand that you're a new parent and that things are stressful right now. Be clear about what happened and what impression you were given. They have the ability to fix just about everything.

GL!

chiromommyMichelle

Also, if your baby's initial claims right after birth were submitted electronically, they may have beaten your HR up date to the claims clearinghouse.  Verify with HR that the baby was added, per your prior conversation, then contact all providers to resubmit the claims.