How do I insure a newborn on short notice?
May 22, 2014 4:02 PM Subscribe
We just found out the baby we're having any day now is probably not eligible for medical care at birth on her mother's insurance plan. Help!
My wife is 38+ weeks pregnant and still insured by her parents' BCBS of Tennessee policy. We live in Washington state. We were told by an insurance adviser that the Erin Act would guarantee that the birth (and neonatal care) is covered by that.
Today our midwife told us she was pretty sure that wouldn't work, because family insurance policies can't cover grandchildren. This floored us because there is likely no time to make other arrangements now.
I am not insured at present, either. My enrollment with my employer's provider is still pending. I only applied for myself anyway, as our plan was to add the baby to my policy after she is born. (Even if I wanted to add her before then, how could I if we don't have a birthdate or SSN for her?) My wife will remain on her parents' plan until she turns 26 next year.
If we're about to face a crisis, how can we possibly avert it at this late date?
I have no idea how insurance coverage for childbirth even works. What is covered by my wife's policy and what do they expect baby to have her own coverage for? We're in that uncomfortable financial position of making too little money to pay for the birth out of pocket, and too much to qualify for state assistance. It doesn't help that the two of us are completely overwhelmed by the complexity of the insurance world and frustrated that we can't just get straight answers anywhere, including BCBS.
My wife is 38+ weeks pregnant and still insured by her parents' BCBS of Tennessee policy. We live in Washington state. We were told by an insurance adviser that the Erin Act would guarantee that the birth (and neonatal care) is covered by that.
Today our midwife told us she was pretty sure that wouldn't work, because family insurance policies can't cover grandchildren. This floored us because there is likely no time to make other arrangements now.
I am not insured at present, either. My enrollment with my employer's provider is still pending. I only applied for myself anyway, as our plan was to add the baby to my policy after she is born. (Even if I wanted to add her before then, how could I if we don't have a birthdate or SSN for her?) My wife will remain on her parents' plan until she turns 26 next year.
If we're about to face a crisis, how can we possibly avert it at this late date?
I have no idea how insurance coverage for childbirth even works. What is covered by my wife's policy and what do they expect baby to have her own coverage for? We're in that uncomfortable financial position of making too little money to pay for the birth out of pocket, and too much to qualify for state assistance. It doesn't help that the two of us are completely overwhelmed by the complexity of the insurance world and frustrated that we can't just get straight answers anywhere, including BCBS.
Definitely call BC/BS and explain the whole situation; don't take the midwife's word for it. Also, check with your employer about whether qualifying life events (like the birth of a child) make it possible for you to add/remove people from your plan.
posted by ThePinkSuperhero at 4:09 PM on May 22, 2014 [5 favorites]
posted by ThePinkSuperhero at 4:09 PM on May 22, 2014 [5 favorites]
In Texas l know BCBS definitely sold plans that covered grandchildren, but usually as dependents. However, it varied. Can you talk to your inlaws and get them to look through their paperwork?
Most employee insurance allows you to add babies as soon as they are born, so your real dilemma is coverage for your wife. Keep pestering BCBS until you get a clear answer.
posted by emjaybee at 4:12 PM on May 22, 2014
Most employee insurance allows you to add babies as soon as they are born, so your real dilemma is coverage for your wife. Keep pestering BCBS until you get a clear answer.
posted by emjaybee at 4:12 PM on May 22, 2014
Ah, also, after a qualifying event, changes are often retroactive. This is something you should call your insurance and asked about, but in general as long as you sign up the new baby on your plan within 30 days, it should be able to cover the baby retroactively to birth. Call your new pending insurance company and verify with them how that works.
posted by brainmouse at 4:13 PM on May 22, 2014 [1 favorite]
posted by brainmouse at 4:13 PM on May 22, 2014 [1 favorite]
Response by poster: My wife called BCBS and was on hold for an hour, kept getting transferred to different departments, and couldn't get satisfactory answers from anyone. I wasn't present for the call, and that was before today's bombshell.
She admits that she's as befuddled and intimidated by the insurance system as I am, and probably didn't ask the right questions because she didn't know what to ask. Her anxiety (literal clinical, crippling anxiety) about going through the whole thing a second time is preventing her from trying it. I should see if I can call and get a little further than she did. That is probably the best next step at this moment.
posted by The Winsome Parker Lewis at 4:14 PM on May 22, 2014
She admits that she's as befuddled and intimidated by the insurance system as I am, and probably didn't ask the right questions because she didn't know what to ask. Her anxiety (literal clinical, crippling anxiety) about going through the whole thing a second time is preventing her from trying it. I should see if I can call and get a little further than she did. That is probably the best next step at this moment.
posted by The Winsome Parker Lewis at 4:14 PM on May 22, 2014
You really can't trust anyone's word for what is or is not covered other than that of the insurance company itself, even then, make sure you get stuff in writing. If you need to add the baby to your plan, you typically have a certain amount of grace period to get them added, but you need to check with your provider for the details. Don't worry about the SSN for now.
posted by Rock Steady at 4:16 PM on May 22, 2014 [1 favorite]
posted by Rock Steady at 4:16 PM on May 22, 2014 [1 favorite]
They will probably not talk to you, as you are not a policy holder. Can you ask your in-laws to call and get the relevant info faxed or emailed to your wife?
posted by Rock Steady at 4:18 PM on May 22, 2014 [1 favorite]
posted by Rock Steady at 4:18 PM on May 22, 2014 [1 favorite]
Is there any way your wife's parents have information about what the plan covers?
posted by bleep at 4:19 PM on May 22, 2014
posted by bleep at 4:19 PM on May 22, 2014
Response by poster: Good idea, I'll see if the in-laws can help. Would BCBS talk to me if my wife was there with me on speakerphone?
posted by The Winsome Parker Lewis at 4:22 PM on May 22, 2014
posted by The Winsome Parker Lewis at 4:22 PM on May 22, 2014
Yes, if your wife is there and okays them to speak with you, they likely will (Humana has done that for me and my husband).
posted by needlegrrl at 4:28 PM on May 22, 2014 [1 favorite]
posted by needlegrrl at 4:28 PM on May 22, 2014 [1 favorite]
Costs from the birth related to your wife will be covered under the BCBS plan as you anticipated. But your child starts accruing bills as soon as they're born. You will be able to add your child to your health insurance for thirty days beginning on the day he or she is born, retroactive to that day or the day your insurance takes effect if that is later. So if the midwife is right the key day is the day your insurance takes effect. Do you know when that is?
posted by gerryblog at 5:08 PM on May 22, 2014 [2 favorites]
posted by gerryblog at 5:08 PM on May 22, 2014 [2 favorites]
Also, in line with what The Pink Superhero said, "qualifying life event" means you can add a new person (spouse, child, etc.) to your plan after starting it and between renewal periods. And it can be retroactive to application date. So if, a week from now, you have insurance through your employer and 3 days later you have a baby, you should be able to add her/him right away. So you can relax about at least that part (and you must be able to add the kid without a SS number, since there's a delay in getting one of those).
Hang in there. This sounds very anxiety-producing. For what it's worth, I think an answer will be found.
posted by acm at 5:28 PM on May 22, 2014 [1 favorite]
Hang in there. This sounds very anxiety-producing. For what it's worth, I think an answer will be found.
posted by acm at 5:28 PM on May 22, 2014 [1 favorite]
I'm not an insurance person, but I'm pretty sure the midwife is just wrong. The Erin Act page you link to explicitly covers this question:
"if your employee’s daughter is enrolled as a dependent on your employee’s PEBB medical insurance and gives birth, the Erin Act’s 21 days of coverage would be available to that newborn."
In this paragraph, the 'employee' is your parent-in-law who is enrolled in a plan, their daughter and enrolled dependent is your wife, and the newborn is your kid, which gets 21 days of coverage when it is born. The rest of the paragraph says that the newborn will not be eligible to enrol in the plan as a dependant, but that means for ongoing coverage after the 21 days is up. The law basically says that a Washington plan that provides covers the cost of a birth for the mother must also cover it for the child being born, no matter how the mother is enrolled in the plan.
The bit that makes me not positive is that you have a policy from another state, and I don't know if they are required to follow the Erin Act or not, as that is WA law only. Try calling the state health insurance commissioner to see if that law is invoked just by you being a resident here.
posted by the agents of KAOS at 6:32 PM on May 22, 2014 [1 favorite]
"if your employee’s daughter is enrolled as a dependent on your employee’s PEBB medical insurance and gives birth, the Erin Act’s 21 days of coverage would be available to that newborn."
In this paragraph, the 'employee' is your parent-in-law who is enrolled in a plan, their daughter and enrolled dependent is your wife, and the newborn is your kid, which gets 21 days of coverage when it is born. The rest of the paragraph says that the newborn will not be eligible to enrol in the plan as a dependant, but that means for ongoing coverage after the 21 days is up. The law basically says that a Washington plan that provides covers the cost of a birth for the mother must also cover it for the child being born, no matter how the mother is enrolled in the plan.
The bit that makes me not positive is that you have a policy from another state, and I don't know if they are required to follow the Erin Act or not, as that is WA law only. Try calling the state health insurance commissioner to see if that law is invoked just by you being a resident here.
posted by the agents of KAOS at 6:32 PM on May 22, 2014 [1 favorite]
gerryblog is exactly right; most of the bills will relate to your WIFE, who is covered, and you have 30 days to add the baby to a plan. (Sometimes it takes six weeks to get an SSN but THE BUREAUCRATS CAN DEAL WITH THIS. It may take a couple hours on the phone, but they deal with it all the time.) For reference, my part of the bill for my first baby was around $12,000 and the baby's part was around $3,000 (obviously those are just the imaginary numbers the hospital sends the insurance company, not real numbers that anybody paid). My part included my hospital stay, the delivery itself (spendy!), the anesthesiologist (very spendy!), my post-natal care and recover, hospital food and drugs, etc. The baby's part included a couple nights in the nursery and some shots and a couple other things. The baby's part is much, much cheaper.
And definitely call the state insurance commissioner or ombudsman. They are extremely helpful and they are used to people crying on the phone because health insurance is stressful and dumb. They are very, very good at sorting things like this out, and helping you figure out the right people to be talking to, the right direction to attempt, and what your rights and options are.
posted by Eyebrows McGee at 7:30 PM on May 22, 2014
And definitely call the state insurance commissioner or ombudsman. They are extremely helpful and they are used to people crying on the phone because health insurance is stressful and dumb. They are very, very good at sorting things like this out, and helping you figure out the right people to be talking to, the right direction to attempt, and what your rights and options are.
posted by Eyebrows McGee at 7:30 PM on May 22, 2014
Your in laws may also have access to a health care advocate who can get through this muddle & return clear legit actionable answers.
posted by tilde at 7:46 PM on May 22, 2014 [1 favorite]
posted by tilde at 7:46 PM on May 22, 2014 [1 favorite]
Building off of Eyebrows McGee, my insurance company just required a hospital or midwife's birth certificate in order to add my baby to the plan. (This was last summer.) Then, when we got a SSN, we updated the plan at that time.
The baby being born is a qualifying event to add the baby to your insurance. And you can't add the baby until he/she is born.
posted by jillithd at 6:48 AM on May 23, 2014
The baby being born is a qualifying event to add the baby to your insurance. And you can't add the baby until he/she is born.
posted by jillithd at 6:48 AM on May 23, 2014
So adding kids to a policy is usually retroactive to the day they were born, precisely because you can't give them the SSN/DOB until then. Call your HR people, explain that you are expecting a baby and they will tell you what to do. Usually you have a certain amount of time (30-60 days) to send them the birth certificate, etc to get your child covered and that coverage will be retroactive to the child's DOB. If you fail to get that info in, you will be out of luck for any costs during that time, so get the paperwork in, but otherwise you will be fine. The hospital will understand how this works and everything will go fine. I say this as someone who has had 2 kids recently : )
As far as your wife's insurance, the only thing to do related to getting your child covered that way is to keep calling until you get an answer and have them sending it to you in writing. But getting coverage through your work might be easier.
posted by katers890 at 8:40 AM on May 23, 2014
As far as your wife's insurance, the only thing to do related to getting your child covered that way is to keep calling until you get an answer and have them sending it to you in writing. But getting coverage through your work might be easier.
posted by katers890 at 8:40 AM on May 23, 2014
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posted by brainmouse at 4:05 PM on May 22, 2014 [5 favorites]