'Birthday Rule' Blindside'Birthday Rule' Blindsides s First-Time Parents With A Mammoth Medical Bill

[Northeast Agent]

'Birthday Rule' Blindsides First-Time Parents With A Mammoth Medical Bill

The Kjelshus family had slammed into something well known among insurance experts but little understood by the general public. "Coordination of benefits" and "the birthday rule" are the jargon terms for the red tape that snared them.

When a child is born into a family in which both parents have insurance through their jobs, the parents are supposed to "coordinate benefits'' — meaning they must tell both insurers that their child is eligible for coverage under two plans. The parents might be forgiven for thinking they have some say in how their child will be insured. In most cases, they don't.

Instead, a child with double health insurance eligibility must take as primary coverage the plan of the parent whose birthday comes first in the calendar year; the other parent's insurance is considered secondary. This model regulation was set by the National Association of Insurance Commissioners and adopted by most states, including Kansas, says Lee Modesitt, director of government affairs with the Kansas Insurance Department.

 

[fed up]

Seems like the Hospital owes much more than an "oops, never mind" If I told a hospital, "oops, forgot" I would receive bills and demand letters until my credit was in the tank and I had a write-off showing plus new calls from each new collection company that buys the old bill. Wonder how the hospital management would react to a demand letter for the stress that they caused?

 

[somarco]

Admittedly, I just skimmed the article, but . . .

It seems the parents were aware the mom's policy was the "better" option, yet they apparently put the child on BOTH parents plan . . .

For years I have counseled clients against "double coverage" yet many times they insist they get better coverage with two plans.

It rarely happens that way.

 

[leevena]

Something does not make sense here. I cut and pasted a section below. It says that the couple decided to cover the child on the wife’s plan, and when working with the hospital, provided that information to them. Later in the article it is disclosed that the child was eventually enrolled on the fathers plan. Am I missing something here? It appears the family told them about the BCBS coverage and not the “later added” coverage.


The couple had decided that Kayla, a nurse practitioner, would carry Charlie on her insurance plan through Blue Cross and Blue Shield of Kansas City. Her plan offered better rates than Mikkel's, and his plan was based in another state and carried a higher deductible. So when the hospital asked for insurance information, Kayla provided her policy number — Mikkel did not.

Charlie Kjelshus, an infant covered by her mother's plan through Blue Cross and Blue Shield of Kansas City and, eventually, her father's plan, CommunityCare of Oklahoma

 

[somarco]

Something does not make sense here. I cut and pasted a section below. It says that the couple decided to cover the child on the wife’s plan, and when working with the hospital, provided that information to them. Later in the article it is disclosed that the child was eventually enrolled on the fathers plan.

Birthday rule would apply if both plans were in effect from birth.

Group plans usually require the parent(s) to notify the carrier within 30 days of the birth. If that happens on a timely basis, coverage(s) is backdated to the day of birth.

I don't believe we know the timeline for the "eventually enrolled" date is, nor when the father's group plan was effective for the child.

If the father notified his group plan in the 30 day window then presumably BOTH plans were retroactive to the date of delivery and the birthday rule WOULD apply. If notified AFTER the 30 day window COB could still apply but only from the point where the father's plan was effective for the child.

As you indicated, seems to be some missing pieces.

 

[marindependent]

Thanks for the Awesome Post.