Help Needed: Birth of Our Daughter and Insurance Issues
Hi everyone,
I’m reaching out for some guidance regarding a tough situation we’re facing. My girlfriend (the mother) and I (the father) welcomed our baby girl on May 24th. We each have separate health insurance plans—she has Blue Cross Blue Shield Michigan (BCBSM) through Trinity Health, and I hold a Federal Employee BCBS plan. We promptly added our daughter to my insurance, and her coverage was made retroactive to her birth date.
However, we recently received a $5,000 bill from the hospital in my daughter’s name. The hospital initially submitted the claim to my girlfriend’s insurance, but it was denied because she is “not an eligible dependent under the policy.” Afterward, they submitted the claim to my insurance, which was also denied 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. Because 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 greatly appreciate any advice or insights on how to navigate this situation. Thank you!
I’m sorry to hear about the challenges you’re facing with your baby’s medical bills. Here are some steps you can take to address the situation:
Contact Both Insurance Companies: Reach out to both your girlfriend’s insurance (BCBSM) and your Federal Employee BCBS to clarify the significant misunderstanding. Ensure you have all pertinent information handy, including your baby’s birth date, policy numbers, and any documentation related to the claims.
Verify Eligibility and Coverage: Double-check that your girlfriend’s policy is active and that she was a covered member at the time of delivery. Sometimes, small details can lead to claims being denied. Ensure that the baby was enrolled correctly in your policy.
Request a Claims Review: If the claims have been denied due to eligibility, formally request a review of your baby’s coverage situation from both insurance companies. Make sure to provide any documentation that supports your case.
Speak with the Hospital’s Billing Department: Communicate with the hospital’s billing department to explain the situation. Sometimes they can offer assistance in getting claims properly re-submitted or may have experience dealing with similar cases.
Seek Help from the Insurance Ombudsman or State Insurance Department: If you continue to face challenges, you might want to contact your state’s insurance department or an ombudsman for assistance. They can offer guidance on how to navigate insurance disputes.
Document Everything: Keep detailed records of all communications with the insurance companies, the hospital, and any other relevant parties. This documentation will be crucial if you need to escalate the issue.
Explore Medicaid or Alternative Coverage: If the situation cannot be resolved through your current insurance, you may want to explore alternative coverage options for your baby, such as Medicaid or the Children’s Health Insurance Program (CHIP), depending on your income and eligibility.
This situation can be incredibly frustrating, but persistence is key. Good luck, and I hope you find a resolution soon!