Newborn Health Insurance Denied

Updated on October 15, 2013
G.V. asks from Shelby, NC
15 answers

Hi,
Very thankful to see this website and answers for every questions. When I was with my first employer, my child was born. I added her as a dependent but unfortunately I missed to add her in the medical insurance plan. So, it seems she was not enrolled into benefits within 31 days of birth. Now I am with another employer. Some of the claims were rejected by Insurance company and I own those bills now. I called my first employer, they said they can not do anything. Is this legal? My first employer did not intimate me that my child needed to be enrolled for the benefits whereas I added my child as dependent. Please advise If I can ask my first employer to take care of this issue.

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So What Happened?

Thanks to everyone for your quick responses. It was not my intention that not to add my child in the insurance enrollment. I completed my 1st step that is adding my child as a dependent. After few days I should have received any letter or email or any form of intimation from my 1st employer asking to add her under the coverage. But they did not send anything. At the same time, I also didn't follow with them and my premium was also not deducted. If I go for legal advise, will that work?

More Answers

B.C.

answers from Norfolk on

It seems you already asked your first employer and they gave you their answer.
You can ask them as many times as you want but I'm not seeing how asking again is going to get you any different answer.

Additional:
There is nothing you can do to get your child insured after the fact and get your doctor bills for that period reduced/paid by he insurance company.
Sure.
Go ahead and ask a lawyer.
The answer is not going to be any different.
How were you pregnant for 9 whole months and never made an appointment with your employers HR department to go over what your options were for getting your baby insured?
YOU make the appointment - THEY do not initiate it.
You no longer work for them and there are no time machines where you can go back and do things differently.
Your child was uninsured at the time when the services were performed.
Now you have to face the music and pay the piper.
Call the doctor(s) and come up with a payment plan.

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P.K.

answers from New York on

You did not add her the your insurance, she is not insured Nothing you can do. Did you add her onto your insurance at your new job.

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A.V.

answers from Washington DC on

You didn't add your child to the insurance and are no longer employed by them. They probably can't change it even if they wanted to. I would call the physician and explain that there was a problem with the insurance and how can you set up a payment plan? Some doctors will give you a discount if you work with them.

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D..

answers from Miami on

Yes it's legal. It was your responsibility to have added her in the first place, and you didn't remember to. You would have had to wait until open enrollment if you hadn't changed jobs. Now you have insurance thankfully, but you are still responsible for the bills before she was covered. I doubt that your previous employer will cover anything, so sorry.

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M.P.

answers from Raleigh on

Unfortunately, yes it's legal. It's your responsibility, not your employer, to notify insurance when you want to add a dependent to your insurance plan. Adding her as a dependent to claim your benefits, such as life insurance, is different. I know this is not what you want to hear, and I'm so sorry you are going to have go through this. However, you are going to be responsible for the full bills. Ugh.
For all they knew, you put the baby on a spouse's insurance plan or other plan and opted out of their coverage. The employer generally does not notify you that you need to do anything with health insurance when you have a baby. :( I know I had to call the HR dept, do my research, and take care of all of this myself.
The best you can do is negotiate with the doctor's office over reducing the bill, or at best, set up a payment plan.

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M.P.

answers from Portland on

When I first enrolled in insurance I received written information from the insurance company regarding the use of that insurance. Included in that document was how to add dependants after a change in status to include marriage, birth, adoption. I did not expect to have a change in status but I filed that away in my brain just in case. When I planned to adopt many years later I went to Human Resources to ask how to add her. Knowing what is on your contract with the insurance company is each emplyoyees responsibility. Human Resouce Department is there to help you but they are not responsible for what you do or don't do. Your employer doesn't get involved in your health care. They may provide access to health care (not all do) but what you do to utilize that care is each emplyoyees responsibility.

You added ypour baby as a dependent for tax purposes. Doing so is unrelated to insurance. In fact the person who took the dependent information may be a different person than the one handling insurance information.

After MamaDuck's comment, she is right you are telling HR baby is a dependent eligible for insurance coverage. You then notify the insurance company of the addition. It would make sense for them to then tell you how to do that but the ultimate responsibility is yours.

My experience with medical offices is for them to confirm insurance coverage at first appointment. My latest granddaughter had her first appointment with pediatrician at 4 weeks. Did you then go to HR and ask for help or call the insurance company in a calm pleading manner? They may have bbeen able to help you then. Now it's too late.

I am sympathetic. Unfortunately this was an expensive lesson. Now you know to ask questions and not rely on others to take care changes in your life. Perhaps one of the most important lessons for me was the realization that I frequently thought I understood/knew things and therefore didn't ask questions. I learned to ask and ask and ask even when I felt stupid when I asked. I took care of the stupid feeling by saying something like "do I understand correctly that this takes care of the insurance. " no stupid feelings that way.

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C.O.

answers from Washington DC on

ETA: No, if you try for legal - you'll be wasting your money. YOU FAILED TO FOLLOW THROUGH. Sorry to be blunt - but really - it is NOT the employers responsibility to hold your hand. If you knew what was supposed to happen - a letter - and it didn't happen - you should have contacted your HR department and told them - I don't have the letter. Then you should have put it in writing - that way you would have back up showing you TRIED to resolve the issue.
______________

G.:

Welcome to mamapedia!!

Are you in the United States or are you in another country?

If you are in the United States - it is YOUR responsibility to add your children to your medical insurance and anything else you need to add them to - wills, living trusts, etc.

Just because you added your child as a dependent - does NOT mean you ENROLLED your child in health care. If you believe otherwise and have paperwork showing that you DID enroll her - then they have to backdate everything and pay the claims, if they are covered.

You owe the bills from the previous doctor visits. It's not the doctor's fault you did not enroll your child. If you cannot afford to pay them all at once? Make payment arrangements with the doctor's, but you owe the money. Sorry.

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S.B.

answers from Dallas on

You can ask anything you want to but they are probably not liable for the bills if you did not enroll your child and you did not pay a premium. That is your responsibility. The employer must follow the contract dates it has with the insurer. It would have been nice for the employer to confirm that you did not intend to enroll your child but they are under no obligation to do so. ((it could be that you intended to have the child added to a husband's insurance or that you were applying for medicaid coverage)) So you might check with the doctor to see if you can get a discounted rate since your child was not covered or work out a payment plan.

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S.B.

answers from Kansas City on

You didn't add her to the insurance so she didn't have insurance. How long have you been with the new employer? Is she added to this insurance? Were the bills rejected by the insurance company from before she was on the new insurance? If they're from before she was added to the new insurance, you are liable for them and need to talk to the doctor's billing department about how you're going to be paying it.

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T.T.

answers from Washington DC on

Ahh, I sympathize. When our first child was born, we were unaware that there was a 31-day window in which to add him to my husband's health insurance. I didn't find out we weren't covered until I went in for one of his well baby check-ups. Luckily for us, we were able to go back to my husband's HR department, and they found a way to let us enroll.

So that being said, I'm curious why didn't you try to get your baby on your health plan once you realized she wasn't covered? You must have known she wasn't if you were incurring doctor bills during that time, right? Even if your employer didn't tell you that you needed to add her, surely the doctor's office told you she wasn't covered. If they didn't, maybe you can go back to them and ask them if you can work out some sort of sliding scale payment plan.

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O.H.

answers from Phoenix on

You have 31 days to add a newborn to your medical insurance. End of story. If you miss that deadline, there is NOTHING else you can do. Tough lesson learned. When you were hired by your NEW employer, you had the chance to add ALL of your dependants so hopefully you did that. If you didn't, you have to wait until your next Open Enrollment which is generally once per year. If you DID add your dependants with your new employer, the coverage starts on THAT effective date. It will NOT be backdated or cover PRIOR medical bills. So if you are looking for a way around this, there isn't one. Good luck.

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G.F.

answers from Philadelphia on

I am confused, you changed employers and didn't add your child again or you now added your child with the second employer and the claims are rejected? If you have a lapse in insurance then a new employer's insurance will not cover some things for a period of time spelled out in their contract. Is that what you are trying to figure out?

Regardless your employer did not break any laws so there is nothing you can do to compel them to pay your bills if that is what you are going for.

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J.T.

answers from Dallas on

yes, what they "did" is legal... they didn't "do" anything. it is the responsibility of the EMPLOYEE(aka parent) to add a newborn child to their insurance plan within 30 days - same limits apply to any "life event" as insurance terms it, adding spouse due to job loss/marriage, adding an adopted child, etc. you dropped the ball and the medical bills are now your responsibility. your employer cannot add your child, THAT would be illegal, YOU have to do that. contact the medical provider and start making payment arrangements. lesson learned, now you know.

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M.T.

answers from New York on

How is it that employees are expected to know to have added their newborn to the heallth insurance policy? If you received anything like a schedule of benefits document, where this was listed, you'd have been liable to know this even if the document was 70 pages long. If your employer did not inform you in any way, then you might have a leg to stand on. I remember when I was pregnant, receiving a letter in the mail from the health insurance company reminding me that I needed to inform them within X days of the birth to add the baby to the insurance policy.

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C.B.

answers from San Francisco on

You missed enrolling her. It's not your employer's job to make sure your kids are added to the insurance plan. That's your job. There is nothing the employer can do - if she wasn't insured, then she wasn't insured. You can't get it retroactively. That happened to me also. It was my fault and I paid out of pocket for her first year of medical expenses.

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