Newborn Covered by Insurance?

Question

My friend's baby was born one month early. She was in the NICU for 5 days due to breathing problems. My friend has health insurance and so does her fiance (seperate policies, different companies). The finance was going to cover the child when she was born.

The insurance said she should have been pre-enrolled b/c nicu is not typical newborn charges... and the finances' insurance say they are not responsible until after the 14th (she was born a month earlier than that). jill said my insurance only pays if we are in the hospital the same amount of time.. if she stays longer she is a dependant and wasnt eligable to be added to the fiance's yet.. it makes no sense... and how could she be pre-enrolled.. The finance went in april and tried to add her to his and they said wait til she is born... and she came a month early according to my doc so how could she have added her to mine? The letter she got from the hospital said the baby is covered automatically under the mothers insurance for 30 days after they are born.

So; who is responsible for the $26,000 bill for the NICU?

Answer 1

Once the baby is born, you have thirty days from the date of birth to add them, retroactively, effective the birth date, to your group policy.

A company does not have to add the baby, if you have an individual policy.  

MOther or father, should be able to add the baby to their policy, within 30 days of the actual date of birth.  

I've never heard of a company allowing you to add a baby, before they are born.  You NEED a date of birth, and a social security number, to add them.  Which, obviously, you can't get until the baby is born.  

The baby is NOT automatically covered for 30 days under the mother's insurance.  The hospital can't "make" the insurance automatically cover the baby.  I'm sure the letter doesn't say that, in those words.  Or if it does, it also says, "this isn't binding".  Baby's normal room & board, ONLY, is covered for that first 30 days.  Not shots, not NICU, nothing else.  

If it's been more than 30 days, and the baby hasn't been added (or hopefully, her insurance gave her that letter within the first 30 days so she has proof she tried to add the baby right away), mom and dad are responsible for the bill.  

If you have that letter, within the first 30 days, saying she couldn't add the baby, until after th 14th, you take a copy of it, and file a complaint in writing to the NC insurance commissioner.  

Answer 2

You have 30-31 days to enroll a newborn.  I have never heard of anything called "pre-enrolled."   You have the right to enroll the baby in either Parent's plan.

Answer 3

Different states have different guidelines---but for the most part, as long as they baby is enrolled within 31 days, they will be covered from the date of birth. There's no way to pre-enroll a newborn because the baby has to be actually born to be a member on the insurance. I'd have the mom (or the fiance-whichever is enrolling the baby) speak with their benefits administrator or human resources at their job because it sounds like they're getting wrong information from the insurance company.