Help Needed: Denied Coverage for Newborn’s Birth Expenses
Hi everyone,
I’m in a bit of a tough situation and could really use some guidance. My girlfriend (the mother) and I (the father) welcomed our baby girl on May 24. We both have separate health insurance plans: she has Blue Cross Blue Shield Michigan (BCBSM) through Trinity Health, while I have Federal Employee BCBS. When our daughter was born, I promptly added her to my insurance, ensuring her coverage was retroactive to her birth date.
However, we’ve hit a roadblock. We’ve received a $5,000 bill from the hospital under our baby’s name. The hospital initially submitted the claim to her insurance, but it was denied because she “is not an eligible dependent under the policy.” We then asked the hospital to resubmit the claim to my insurance, only to face another denial with the following explanation:
Remark Code: 273
“Routine nursery care provided to a newborn is covered when performed during the mother’s covered maternity stay. Since the newborn’s mother is not a covered member, services provided to the newborn are also not covered. Therefore, you are responsible for all charges.”
I would appreciate any advice or insights on how to resolve this issue. Thank you!
I’m sorry to hear about the struggles you’re facing with your baby’s coverage. Here are some steps you can consider to address the situation:
Contact Mom’s Insurance: Since the hospital initially submitted the claim to your girlfriend’s insurance, reach out to them for clarification on why the baby is not considered an eligible dependent. It might be worthwhile to double-check the coverage details regarding newborns as there can sometimes be exceptions or additional paperwork that needs to be completed.
Gather Documentation: Collect all relevant documents, including the birth certificate, insurance cards for both plans, and any correspondence from the hospital and both insurance companies. This information will be helpful when you dispute the charges.
Speak with the Hospital Billing Department: Contact the hospital’s billing department to explain the situation. They may be able to provide guidance on how to navigate the claim denials or help facilitate resubmission with the correct information.
File an Appeal with Insurance Companies: If necessary, you can file an appeal with both insurance companies. Detail the situation, and include all necessary documentation that confirms your baby’s coverage under your policy and the circumstances of the denial.
Review Insurance Policies: Make sure to carefully review both insurance policies regarding coverage for newborns to ensure you’re fully aware of your rights and responsibilities, as well as any timeframes for adding the baby to the policy.
Consider Medicaid or Other Assistance: If the situation becomes overwhelming, you may want to explore Medicaid or state assistance programs that could help cover the hospital charges for your newborn, if she qualifies.
Seek Legal Advice: If the situation is not resolved after exhausting all options, you might benefit from seeking legal advice. An attorney who specializes in health insurance or family law may be able to help you navigate the complexities of insurance disputes.
I hope you find a resolution soon! Don’t hesitate to reach out for more specific issues or updates as you go through this process.