[PA, NJ] spouse’s medical health insurance retains refusing to pay for price of kid beginning.

By | June 12, 2019

Spouse and I each work in PA and stay in NJ. Little one was born in NJ in August 2018. It was at all times our intention to have our little one coated below my spouse’s plan. Little one spent ten days within the NICU racking up some unbelievable hospital payments. She shortly added him after he was born. Hospital was by no means even given my insurance coverage info. Reduce to: A couple of months later, we’re getting calls about owed medical payments. The hospital was saying that my spouse’s insurance coverage was rejecting the declare. That is the place we came upon concerning the so-called “birthday rule”. The hospital knowledgeable us that the legislation in NJ says the kid should be on my insurance coverage as a result of my birthday comes first within the yr. They ended up billing my insurance coverage, who rejected some claims. Spouse calls her insurance coverage and lets them know that our son is solely not on my plan. We predict that is a straightforward repair. Nevertheless, her insurance coverage suggests we again date him to my insurance coverage for not less than the primary month of life to clear up confusion. That is when my instincts begin to kick in. Since it’s already December by this level, my insurance coverage tells me they will’t again date that far. And so they may solely return to November. I clarify to them the scenario; they usually don’t perceive what my spouse’s insurance coverage is doing. If he’s not on my plan then the birthday rule doesn’t apply. That is additionally once I discover out that this “rule” isn’t actually a legislation however a solely a normal enterprise apply for twin insurance coverage. I inform my insurance coverage to not trouble as we are going to simply go along with my spouse’s insurance coverage. A dialog with my HR rep confirms my assumption. We get in contact with spouse’s insurance coverage once more and clarify the scenario. They appear to know that they’re within the improper and we’re given a private assurance that they are going to handle it. This course of repeated greater than as soon as. Basically having us go in circles: Saying EOBs from insurance coverage will repair this challenge, sending EOBs, getting a response agreeing with our place, getting one other cellphone name from the hospital, which ends up in us once more calling insurance coverage and basically asking for a similar info over again. It’s now June and we obtained one other name from the hospital asking for fee or we can be despatched to collections. We name my spouse’s insurance coverage who mentioned they are going to name the hospital to delay sending to collections. Nevertheless, they preserve saying that my insurance coverage needs to be the one overlaying and it needs to be processed by them first. The ultimate twist is it appears my insurance coverage truly DID pay a few of the payments throughout his hospital keep in August. We don’t know how that even occurred. In addition they DID add him in my insurance coverage for the month of November, once I requested if he might be again dated however ended up not going by with it. Since this time we’ve had physician’s go to and different therapies fully coated by my spouse’s insurance coverage. How can we coordinate with all events to lastly get some closure? If my insurance coverage did mistakenly pay for some hospital payments what are the implications of that? Spouse has Aetna, I’ve Independence Keystone. submitted by /u/throwawayuserno17582 [link] [comments]