Home » LAW »» Insurance Law

Help with newborn coverage (Insurance Law)

Mon, 10 Jul 2006 10:51:00 GMT

What is the name of your state? Mississippi
I'd really appreciate your advice regarding our situation.
I am currently in the state's risk pool due to a pre-existing condition that makes me otherwise uninsurable. My husband and toddler daughter are covered by private individual insurance, as health insurance is not available through his work. The risk pool does not allow any other individuals to be added to my policy.
In January, we called Assurant, my husband's insurer, to tell them we were expecting twins in April. They told us we had a certain number of days after the birth to add them in order to have them covered as of the date of birth.
After the birth, we added the twins within a week or so. Now Assurant is denying the hospital claims for the twins (about $4000 total). The first time we called, they said the twins were covered now, but were not the day they were born. However, MY insurer, BC/BS, told me that Mississippi law states that newborns must be covered if they are added to the policy within 31 days (which they were).
So we called again. This time, Assurant said routine newborn charges aren't covered because there was no maternity rider on the policy. We were never told about such a rider before. And why would we need one if the pregnant one is not even on the policy?
Basically, his insurer is saying my insurance is responsible for the charges, and my insurer says the reverse.
Are we screwed, or do we have any recourse?
Thanks so much in advance for your reply.

Comments (5) | Promote | Bookmark |

  • Leave a Comment Now.
  • Comments
  • Mon, 10 Jul 2006 21:45:00 GMT(1)
  • No, my insurance cannot cover this, because, as I stated, my coverage is through the state's risk pool. No other person can be added to my policy.
  • Mon, 10 Jul 2006 15:52:00 GMT(2)
  • On the policy that I used to work for, the baby's initial hospital claims were paid under the mom's policy, provided the mom was covered. If the mom was not covered, those bills were usually covered by whatever insurance she did have. Have you discussed the bills with your insurance to see if they are covered as part of your delivery charges?
  • Mon, 10 Jul 2006 18:24:00 GMT(3)
  • I would check with your ins. as suggested by ecmst12. The ins. co. I worked for re individual health policies with family coverage we would insure a child after they were 14 days old or the date they were released from the hosp. whichever is later. This date would be the date of issue (effective date) of child's coverage. (This protected the co. in case of a long hosp. stay after birth or a medical problem that developed before they were 14 days old.) -- not too great for the parents though who had to pay the medical bills. However, Il. (there may be other states also) now require that a newborn child be covered from birth (even if they have med. problems) to an individual or gr. pol. that has dependent coverage. They have "free" coverage for 31 days - but child must be officially enrolled within the 31 days of birth & any prem. paid by day 32. If the policy has no dep. coverage, dep. coverage can be requested on the child within 31 days of birth & the prem. must paid to the ins. co. within 31 days of birth. Also, in Il. the birth of a child creates a special enrollment period under HIPAA - you can add spouse as dependent to your gr. ins. also w/o evidence of insurability as long as they are enrolled within 30 days of birth of child. This applies even if spouse was declined for dep. coverage previously. They may not cover on your spouse pre-existing conditions for 12 mos. - depends on other coverage they had & for how long.
  • Tue, 11 Jul 2006 11:53:00 GMT(4)
  • Hi - ecmst12 & I know no dep. can be added to your coverage - we were just thinking maybe the bills would be paid as part of your delivery charges. Betty
  • Tue, 11 Jul 2006 11:56:00 GMT(5)
  • OP, what does your husband's health insurance policy say? Did you ever read it? Apparently they (the company) are giving you accurate information, and it sounds right to me, but I haven't sold enough health insurance to be sure.
    Edited to add: Many individual policies do NOT cover maternity services because then people would only purchase the policy when they (or spouse) become pregnant. The rider would have been extremely expensive anyway, so it may have been a "wash" by the time the baby was born and the charges were determined. Oh, if I had a $1 for every time I got a call from someone who didn't have insurance looking for maternity and dental coverage...because they were pregnant or needed work on their teeth.
    As far as the law
    Under Mississippi law, newborns are automatically covered under the parents_ individual health insurance policy for the first 31 days, if the plan covers dependents. The insurer may require that the parent enroll the child (and pay the premium) within the 31 days in order to continue coverage beyond the 31 days.
    Pleas read the book that your husband received when he enrolled himself and your older child in the program. Does it say anything about maternity or adding another dependent?
  • Leave a Comment Now.

Insurance Law Open Questions

Help With Icu Stay

What is the name of your state?INDIANA IN 1999 OR 2000 I PURCHASED A CNACER POLICY THROUGH MY EMPLOYER. IT ALSO HAS A ICU RIDER ATTACHED. I HAVE NEVER HAD TO USE ANY OF THIS INSURANCE. IT IS THROUGH A COMPANY CALLED CONSECO. IN JANUARY OF THIS YEAR I HAD A DAUGHTER BORN 9 WEEKS EARLY. SHE WAS......

help with claim

What is the name of your state?What is the name of your state?Ohio Our house was broken into while we were on vacation last week. This is the first claim we've had with our homeowners. Where I need the advise is the company isn't going to pay for my things becasue we are not married. The problem......

HELP PLEASE, bad builder & same insurance as mine

I am in Pennsylvania My house has suffered damage, due to bad construction. My insurance company denied my claim. However, they said that my builders insurance should cover the cost. They even gave me a letter from their engineer, that blames the builder. I have come to find out that my builder......

Help please - Dishonest Surgery center & what can I do?

What is the name of your state? AZ Late last year I was visiting in AZ when I ruptured 3 disks in my back and had all the residual problems associated with that including surgery, medication, and finally a procedure called an injection at one of the local outpatient surgery centers. It was very......

help please

What is the name of your state? California My son is a methamphetamine addict. I contacted my HMO-Cigna and they explained the substance abuse benifits my plan includes. There are 3 levels. Intensive out patient, day treatment, and in patient. They provided me with the network facilities......

help please

What is the name of your state?What is the name of your state?new york...

Help on resolving a problem

What is the name of your state?What is the name of your state? Illinois My daughter was born with a congenital heart disease. She needed a procedure to be performed for which she was transported to another hospital using an ambulance and then back to her birth hospital after she had recovered......

Help on Auto damage issue by Condo building

What is the name of your state? Illinois I live in high-rise building and have outside parking. Few days back, building next door to mine had some stones flying in the night and broke windshields of about five cars including mine. Our building management decided to go with one particular Body......

Help Mom-Life Ins. beneficiary ?'s

What is the name of your state?What is the name of your state? NY My dad lived with another woman for 35 yrs despite still being legally married to my mom even up to the day he died. His companion is the beneficiary on his NY State pension and 2 life insurance policies totalling about $19k.......

Help me-After appendicitis operation Mediclaim is possible

What is the name of your state? TN Hi, I know something about insurance and its plans but not much.I am quite aware of health insurance.Two months ago my grandma undergone appendicitis operation.it was succeeded.Now she is in good condition.she was fifty years old.My question is, Is she......

Some questions maybe you're interest in...

What laws protect a comedian?

[Consumer Law & Fraud] What is the name of your state?What is the name of your state?What is the name of your state? CALIFORNIA I'm creating an "edgy humor" website and would like to make sure I'm not going to get my pants sued off for doing so. Have you seen sites like http://www.lacunainc.com and.........

Sharing cost to pay for accounting

[BUSINESS & FINANCIAL & Corporate LAW] What is the name of your state? Kansas Our business manager is asking the shareholders to pay a portion of services rendered by the accounting firm before we can receive our final tax statements? Is this legit? Thanx......

What Does the Federal AOP Stand For

[Additional Legal Subjects] I am just curious. No, right or wrong answer. What does the Federal "AOP" stand for? What is the AOP? Is 17 the consent for all 50 states in the USA? I am just curious on how it works. That is all.......

tenting for termites

[Real Estate & Property Law] What is the name of your state (only U.S. law)? California My HOA has nothing in the CC&R regarding pest control. I own a condo in California that is connected to one other unit, and that unit is in escrow and needs to be tented for termites. Do I have to split the cost of tenting with the.........

Chapter 7 & Charged Off Second

[Consumer Law & Fraud] I am getting my first modified. My second charged off. there is no equity. But the second still has a lien on the property. If I do a Chap. 7 can I dump my second in there and will they release the lien? Or How do I get the second to release the lien? I cannot pay. This is CA. Is there a Statue.........

Aspiring Lawyer

[Intellectual Property] What is the name of your state? Illinois. Hey there, I'm 17 years old, going into my senior year of high school, so the college talk is big now. I was plannin on goin into Engineering, probably Electrical, but lately I read some more stuff about Law, and it really appealed to me, but I still.........

A very serious case/ I am very confused

[Family Law] What is the name of your state? My mom lives in GA I am currently living in MD with my father. I am the 15 year old child. My mother has custody of me Child Support started when I was 11 years old. I am currently 15 years old. I was living in TN when my child support started. The first child.........

commission pay Texas

[Employment & Labor Law] I work at a salon/day spa in Texas. Most of us are 50/50 commission, so we only get paid when we do a service (haircut, facial, massage). We have been told by the owner that we have daily "duties" that we have to do, like sweeping, dusting, laundry, washing dishes and other duties. We.........

Ventriculoperitoneal Shunt failure

[Accidents & Personal Injury Law] What is the name of your state? Arkansas Our son was 7 weeks early and was diagnosed with hydrocephalus at 4 months. He had a Ventriculoperitoneal Shunt placed and was fine until April of this year when the catheter was obstructed. They did a revision and he was good until about 3 months later.........

No Valid Registration

[Traffic Law] I went to my county website (lancaster county, Nebraska) and looked up records on myself. I went throught he traffic violations and something shot out at me immediately. On 9/10/2003 it says I received a speeding ticket ; infaction, No valid registration ; CLASS 3 MISDEMEANOR. what the heck??? I.........