Question re: insurance for the babies at birth

ColleenS629 · October 2011

I am currently on COBRA which costs a fortune but is totally worth it to keep the great coverage that I currently have during my pregnancy. DH isn't on the same plan anymore. I don't plan on adding the babies to my plan because I don't plan on keeping it for long after I give birth... I want to add them (and eventually me) to the DH's plan that we also pay for but is much less per month (obviously the coverage isn't as good but that's okay). I know that the babies are covered under my plan for the care that they receive in the hospital and for the first month. I also know that you're supposed to add them to your plan within the first 31 days for them to be covered (that's the exact language my insurance company uses). So here's my question... if I never add them to my plan will they not be covered for the care they received during the first month? Will I be required to pay that back? Or would they be covered for the 31 days but not beyond that? I do plan to ask my insurance company but I'd like to get an idea before I spend hours on hold with them. I also don't think they gave me 100% correct information the last time I called them about something else so I'd like to know what to expect as far as an answer goes before I get the answer from them. Thanks Smile

jinx75 · October 2011

From what I understand they have to be added to the plan within 30 days of birth to be covered on any insurance plan. If you are not going to keep the COBRA coverage why not add them to DH's insurance once they are born? That would probably be the easiest way otherwise they have to be added to the COBRA plan to have any of their services covered.

ETA: I could be completely wrong. I haven't worked the insurance side of medical billing in a long time so it's possible that I don't know what I am talking about.

MandaS08 · October 2011

I would think that they are just covered for those first 31 days, and you don't have to pay it back-but obviously I'm not totally sure.

Could you have a plan lined up that you could add them too very soon after?

Babymamawithdrama · October 2011

I would check, but I believe jinx is correct; having a baby is a change in life event which allows you to change your coverage to include a spouse and or child.... I would call DH's plan to see if you and your LO can be added upon birth of your new little one.... then you will have coverage and not be paying cobra at the same time.... and dump cobra after you give birth. If you never change your coverage I don't believe your child will be insured, the provision only allows to have your child added retroactive to birth, not a 31 day grace period of free coverage. you would still be responsible for the additional coverage.... but again I would double check

haziedaze · October 2011

I think it ends up getting pretty complicated. I'm not sure the coverage for the 1st 30 days is automatic. For instance, if we had added Henry to my DH's plan, I'm pretty sure that it would have been retroactive to his birth. There were issues getting him enrolled in my plan (paperwork didn't go through) and the case manager made it sound like he would have had no coverage if we didn't get things straightened out. Not sure if that's true though, I thought the 30 day thing worked like you said, but then after our dealings I wasn't so sure. Definitely look into it! Good luck... insurance can be very stressful.

jkfranklin · October 2011

I don't know this for sure, but I think the 31 days of coverage for LOs only applies if you add LOs to your policy. If you don't add them ever, those 31 days aren't covered. If you add them to DH's policy within the time frame, then they will retroactively cover all the services of the NB.

I work with health insurance (I do reporting so know nothing about claims processing) but I can ask around to see what is standard if you would like.

meeko1985 · October 2011

I don't have any specific answers to your questions, but my DH and I are currently figuring out our insurance info for next year and it is SUCH A PAIN!!!! It is hard to get straight answers!

iluvmylab · October 2011

They are covered under your plan, but you still have to add them. We will be adding the baby to DH's plan immediately because I am moving to his insurance beginning January 1st. I believe they are only really covered if you add them during that 30 day timeframe. If you do not add them, you'd get billed as the baby not having insurance.

ColleenS629 · October 2011

I talked to them and according to the representative, they will be covered for inpatient hospital care only if they aren't added. So I guess they would be covered for our hospital stay but not for their pedi visits... that would be under their new plan.

ETA: Does this sound right? I'm just nervous that they gave me the wrong information and I'm going to end up getting stuck with the hospital bill.

BlondeBride123 · October 2011

Lurking from TTCAL

ColleenS629:
I talked to them and according to the representative, they will be covered for inpatient hospital care only if they aren't added. So I guess they would be covered for our hospital stay but not for their pedi visits... that would be under their new plan.
ETA: Does this sound right? I'm just nervous that they gave me the wrong information and I'm going to end up getting stuck with the hospital bill.

This info is the same for the health plan I work for. All hosptial services for mother and routine nursery charges for newborn care are covered under the maternity benefit. Anything that is non routine would require the babies to have their own coverage either under your plan or your husband, and should be added within 31 days of their birth. Any services would be paid retro to their DOB.

damabo80 · October 2011

Babymamawithdrama:
only allows to have your child added retroactive to birth, not a 31 day grace period of free coverage. you would still be responsible for the additional coverage.... but again I would double check

This exactly. If I didn't add DD to an insurance plan within that first month, we would have been left with the bills ($175k...ouch)

Just a side note, at least for the delivery, if you already met your deductable with cobra, you may want to add them to cobra, instead of starting over with a brand new deductable under dh, and then close to when the 30 days is up, add them to your dh's plan (after making sure cobra foots the hospital bill).

StaceyM06 · October 2011

BlondeBride123:
Lurking from TTCAL
ColleenS629:
I talked to them and according to the representative, they will be covered for inpatient hospital care only if they aren't added. So I guess they would be covered for our hospital stay but not for their pedi visits... that would be under their new plan.
ETA: Does this sound right? I'm just nervous that they gave me the wrong information and I'm going to end up getting stuck with the hospital bill.
This info is the same for the health plan I work for. All hosptial services for mother and routine nursery charges for newborn care are covered under the maternity benefit. Anything that is non routine would require the babies to have their own coverage either under your plan or your husband, and should be added within 31 days of their birth. Any services would be paid retro to their DOB.

This is what my insurance and DH's insurance told us. We decided to add LO to DH's plan since his deductible is alot lower than my plan's deductible. My insurance told me routine nursery charges vary - if LO has to stay longer in the hospital for jaundice, for instance, that might be billed to LO's plan (under my DH's insurance) rather than under my plan. HTH.

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