Washington State
My wife got pregnant last year under my employer’s old insurance plan. Most of her ultrasound and OBGYN appointments were paid for under that provider’s plan (x) and the deductible was met and “maximum in-network out-of-pocket” was nearly met by the time my insurance provider changed on the 1st of September. Along with this change, my employer made some sort of deal with the new provider (y) to transfer over all deductibles and out of pocket limits from provider -x- to provider -y-.
All well and good, but this transfer may take a while to process…
My wife gave birth to twins in October and we were recommended to enroll in Medicaid to save on the $200 a month from adding them to my current insurance plan. I was also told that my babies would likely be covered under my wife’s deductible for “Newborn Care”. This lead me to stupidly avoid adding them onto my employer’s health insurance -y-, and instead sign up from Medicaid later in the month which resulted in a November start date. However, when I got a bill in the beginning of November stating that my babies had an outstanding balance due to “lack of insurance” I immediately called my Current provider and asked if it was a misunderstanding.
I was notified that the babies needed to be enrolled in my employer’s insurance to take part in the “newborn care” program. I panicked at first because I had thought that I had only 30 days to add the babies onto my plan, and now it had been almost 40. However, I was assured by the insurance agent that the special enrollment period for newborns onto my insurance was 60days after birth, and if I called my employer and enrolled them, they would be covered under the insurance and get the “newborn care” benefits under my wife’s deductible.
I followed the instructions and have since been in contact with the insurance multiple times. I have been trying to get information on the unpaid hospital bills that I have been receiving, but each time, I was assured that it was just a delay in the deductible/out-of-pocket transfer from -x-to -y-.
I have continued to be patient and call occasionally to get an update on the situation, but today I got a call from a children’s hospital telling me I have an outstanding bill related to lack of coverage for my babies. I assured her that this must be some sort of mistake as I have confirmed multiple times that my babies have coverage, and I recommended that she look into the “newborn coverage” that I had, and maybe the issue was that she needed to be looking for my wife’s coverage, and not my babies…
She proceeded to tell me that she already asked about that, and my insurance agent told her that we are not eligible due to my type of plan… I let her know it must be a misunderstanding and I called my insurance provider right away…
Upon calling and questioning the issue, I was told the same thing by the insurance rep. I let her know that this directly conflicts with what I was told before, and I asked her if anything had changed or if she can look up the transcripts from my call in November. She insists that nothing has changed but confirms that there was a call record in November where the agent even noted that I will be opting for coverage under my wife. She told me that this will need to be investigated and a case will have to be opened with management regarding the discrepancy. However, she then informed me that the babies are only recorded to have coverage starting in November! And that I need to contact my employer to back-cover the babies’ birth in October. She said if the babies aren’t noted for being covered in October then there will be issues with opening an investigation/ticket. (she also said this was weird because the babies were clearly born the month before so why would the coverage start then)
I followed her advice and called my employer, who assured me she would look into it and get it fixed, but she also looked in our health plan and found some information stating that the baby’s plan needs to start in the first 30 days for coverage from birth… (Again conflicting with what the insurance rep told me)
Now I am left waiting, but I will continue to follow up with it as I can, but my question is if the insurance has any requirement to uphold information given by their agents? Isn’t this some sort of neglect, because I have now missed opportunities with Medicaid and I am about to have bills go to collections because of this false information, that is on record.
Should I just plan on Paying everything? Should I wait for their investigation? Is there some sort of lawyer I need for them to uphold their statements?
Sorry for the novel, But I am trying my best to get all the details out, for the most accurate advice.
Thank you for your time.
TLDR
Wife gave birth to twins in the beginning of October.
I was assured by an insurance agent that the special enrollment period for newborns onto my insurance was 60days after birth, and if enrolled by then, they would be covered under the insurance and get the “newborn care” benefits under my wife’s deductible.
Two months later I am getting calls for uninsured bills, and my health insurance agency is telling me that all that information was false and they need to investigate, but my babies were only covered from November. If I don’t have the special enrollment and newborn coverage this will mean thousands of dollars of extra bills for me.
This is in Washington State, can they tell me false information with no penalty? Do they need to stand by their statements? What do you recommend as my recourse?
submitted by /u/MusicMixems
[link] [comments]Washington State My wife got pregnant last year under my employer’s old insurance plan. Most of her ultrasound and OBGYN appointments were paid for under that provider’s plan (x) and the deductible was met and “maximum in-network out-of-pocket” was nearly met by the time my insurance provider changed on the 1st of September. Along with this change, my employer made some sort of deal with the new provider (y) to transfer over all deductibles and out of pocket limits from provider -x- to provider -y-. All well and good, but this transfer may take a while to process… My wife gave birth to twins in October and we were recommended to enroll in Medicaid to save on the $200 a month from adding them to my current insurance plan. I was also told that my babies would likely be covered under my wife’s deductible for “Newborn Care”. This lead me to stupidly avoid adding them onto my employer’s health insurance -y-, and instead sign up from Medicaid later in the month which resulted in a November start date. However, when I got a bill in the beginning of November stating that my babies had an outstanding balance due to “lack of insurance” I immediately called my Current provider and asked if it was a misunderstanding. I was notified that the babies needed to be enrolled in my employer’s insurance to take part in the “newborn care” program. I panicked at first because I had thought that I had only 30 days to add the babies onto my plan, and now it had been almost 40. However, I was assured by the insurance agent that the special enrollment period for newborns onto my insurance was 60days after birth, and if I called my employer and enrolled them, they would be covered under the insurance and get the “newborn care” benefits under my wife’s deductible. I followed the instructions and have since been in contact with the insurance multiple times. I have been trying to get information on the unpaid hospital bills that I have been receiving, but each time, I was assured that it was just a delay in the deductible/out-of-pocket transfer from -x-to -y-. I have continued to be patient and call occasionally to get an update on the situation, but today I got a call from a children’s hospital telling me I have an outstanding bill related to lack of coverage for my babies. I assured her that this must be some sort of mistake as I have confirmed multiple times that my babies have coverage, and I recommended that she look into the “newborn coverage” that I had, and maybe the issue was that she needed to be looking for my wife’s coverage, and not my babies… She proceeded to tell me that she already asked about that, and my insurance agent told her that we are not eligible due to my type of plan… I let her know it must be a misunderstanding and I called my insurance provider right away… Upon calling and questioning the issue, I was told the same thing by the insurance rep. I let her know that this directly conflicts with what I was told before, and I asked her if anything had changed or if she can look up the transcripts from my call in November. She insists that nothing has changed but confirms that there was a call record in November where the agent even noted that I will be opting for coverage under my wife. She told me that this will need to be investigated and a case will have to be opened with management regarding the discrepancy. However, she then informed me that the babies are only recorded to have coverage starting in November! And that I need to contact my employer to back-cover the babies’ birth in October. She said if the babies aren’t noted for being covered in October then there will be issues with opening an investigation/ticket. (she also said this was weird because the babies were clearly born the month before so why would the coverage start then) I followed her advice and called my employer, who assured me she would look into it and get it fixed, but she also looked in our health plan and found some information stating that the baby’s plan needs to start in the first 30 days for coverage from birth… (Again conflicting with what the insurance rep told me) Now I am left waiting, but I will continue to follow up with it as I can, but my question is if the insurance has any requirement to uphold information given by their agents? Isn’t this some sort of neglect, because I have now missed opportunities with Medicaid and I am about to have bills go to collections because of this false information, that is on record. Should I just plan on Paying everything? Should I wait for their investigation? Is there some sort of lawyer I need for them to uphold their statements? Sorry for the novel, But I am trying my best to get all the details out, for the most accurate advice. Thank you for your time. TLDR Wife gave birth to twins in the beginning of October. I was assured by an insurance agent that the special enrollment period for newborns onto my insurance was 60days after birth, and if enrolled by then, they would be covered under the insurance and get the “newborn care” benefits under my wife’s deductible. Two months later I am getting calls for uninsured bills, and my health insurance agency is telling me that all that information was false and they need to investigate, but my babies were only covered from November. If I don’t have the special enrollment and newborn coverage this will mean thousands of dollars of extra bills for me. This is in Washington State, can they tell me false information with no penalty? Do they need to stand by their statements? What do you recommend as my recourse? submitted by /u/MusicMixems [link] [comments]Read Morer/HealthInsurance