Author Topic: newborn/health insurance question  (Read 8714 times)

Offline gubevo18

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Re: newborn/health insurance question
« Reply #40 on: June 03, 2018, 12:19:31 AM »
Thank you all for your help.
I called oxford they said that they cover the baby for 48 hours in the hospital or in the event of a C section 96 hours. I called my local health marketplace office and they said that child health plus covers retroactively- even the month before. I asked again "even if baby is born after 15th and I only pay starting next month" they said yes although that part I'm not sure I would trust them 100%. Gonna call someone else to confirm.

Offline nescafe

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Re: newborn/health insurance question
« Reply #41 on: June 03, 2018, 12:48:07 AM »
I called my local health marketplace office and they said that child health plus covers retroactively- even the month before. I asked again "even if baby is born after 15th and I only pay starting next month" they said yes although that part I'm not sure I would trust them 100%. Gonna call someone else to confirm.

IME they only cover retroactively for the months that you pay

Offline gubevo18

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Re: newborn/health insurance question
« Reply #42 on: June 03, 2018, 01:34:40 AM »
IME they only cover retroactively for the months that you pay
yup. That's what I figured. I think the woman I spoke to was mistaken. Although I would be more than happy paying the premium for the previous month as well.

Offline nescafe

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Re: newborn/health insurance question
« Reply #43 on: June 03, 2018, 11:07:52 AM »
yup. That's what I figured. I think the woman I spoke to was mistaken. Although I would be more than happy paying the premium for the previous month as well.
My son was born on the last day of the month. Being that DW's insurance covered for 48 hours, I saves on one months premium

Offline Yehuda25

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Re: newborn/health insurance question
« Reply #44 on: September 21, 2018, 05:29:53 PM »
For a dependant of a dependant?
Be very careful!!!  We got a large bill for this, depends on the insurer and state. And don't trust anything that isn't in writing, what your broker told you will mean nothing when push comes to shove.
“To avoid criticism say nothing, do nothing, be nothing.”


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Offline Yehuda25

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Re: newborn/health insurance question
« Reply #45 on: September 22, 2018, 10:49:02 PM »
Could use some advice... Seems like I may be c"v getting screwed in an insurance situation.

My wife is on her parents insurance (let's call insurance A) and was on it when we first got married, then for the first year or so while she was in school. She then graduated and B"H got a job which gave her insurance, incidentally her work provided her with the same exact insurance and even the same plan name (thought the benefits were slightly different, more or less all matched up).

We didn't think much of it, and kept using for her the insurance card from her parents, as we figured she could just use which insurance she wanted to, and they were the same anyhow.

Comes this january, and her company switches insurances to "Company B". Company B is a completely different company. Not thinking much of it, we keep using her parents insurance for her, as that just seemed simpler then updating all her doctors with the new insurance, married name etc...

All seemed to be going well, had a baby B"H and B"AH all her bills were paid.


Now, we get a call from her OB, that insurance A (her parents insurance) demanded payment back from them (only from January 1st and on though)  - due within 30 days?!?! :'( :'( :'(     (reason given as they were falsely billed as the primary insurance, while PT has insurance from work that should be considered the primary)


So, I started researching based on what I heard from the OBs billing person and found a few crucial pieces of information that we did not know...

Apparently there is a concept of Primary vs Secondary Insurance - Based on my wife having insurance as a dependent (her father's insurance) and from her work - her work should always be the primary...  And the solution to coordinate between the two is by filing a COB (coordination of benefits) to both companies, and having them figure out what the primary and secondary will cover etc...

Who would have thought... We thought you can use whichever you want... Both are being paid for.....


So now - what do we do???

C"V Insurance A can technically go back 18-24 months (NY/NJ) or even possibly unlimited (by saying the DR billed wrong as DR stated they were the primary) and then DR can demand a refund....

B"H the new company has a 12 month window for in network, and 18 month window for out of network, but how do we protect ourselves if they C"V decided to do this to the hospital/other doctors in a year or more from now?


TIA.


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Offline 12HRS

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Re: newborn/health insurance question
« Reply #46 on: September 23, 2018, 02:08:20 AM »

B"H the new company has a 12 month window for in network, and 18 month window for out of network, but how do we protect ourselves if they C"V decided to do this to the hospital/other doctors in a year or more from now?


TIA.

Only advice I can give you is be proactive and get it all taken care of now to protect yourself. Primary insurance should cover it all but it might be a bunch of work.

Offline Yehuda25

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Re: newborn/health insurance question
« Reply #47 on: September 23, 2018, 02:12:35 AM »
Only advice I can give you is be proactive and get it all taken care of now to protect yourself. Primary insurance should cover it all but it might be a bunch of work.
proactive meaning call every Dr she went to and say by the way she has a primary insurance that wasn't billed, please go and Bill this other one? Should I file a cob in the interim as well?
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Offline 12HRS

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Re: newborn/health insurance question
« Reply #48 on: September 23, 2018, 02:22:31 AM »
proactive meaning call every Dr she went to and say by the way she has a primary insurance that wasn't billed, please go and Bill this other one? Should I file a cob in the interim as well?

Not an expert here at all -
Im not really sure what the COB would help. AFAIK the secondary insurance would only cover something that the primary would not (it could be there were a couple treatments/tests that fall under this category and it wouldn't hurt to do that but I doubt its the major amounts).

I would venture a guess also that if the OB is calling the the secondary insurance is going after all the payments they paid out and its only a matter of time before the bills start showing up at your door.

Ideal situation would absolutely be getting the Dr's to resubmit now to the primary insurance.

Offline mgarfin

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Re: newborn/health insurance question
« Reply #49 on: September 23, 2018, 02:52:20 AM »
@ExGingi you are the medical insurance guro out here

Offline ExGingi

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