Question
I changed jobs 14 days after the birth of the new born and did not add my new born to my old employer's insurance, but added him right away with the new employer's plan. Since I did not add my new born with the my old employer's insurance within 30 days (I could not have added him...since I left 14 days after the baby was born), they have denied payment on the hospital bills for the hospital stay of the newborn.
Now, How can I get the old insurance pay? Or is it possible for me to get the claim processed with my new employer's plan?
Help me out. Thanks!.What is the name of your state?
Answer
You could have (and indeed, should have and were obligated to) added him for those 14 days. Now it's too late and you will be responsible for those bills. Employer sponsored health plans have very strict rules about when coverage can be started and stopped, because of federal laws that they have to adhere to. The law says that coverage can only be started or stopped within 30 days of a qualifying event (such as having a baby). If you don't do it in that 30 day window, there's nothing that can be done. Sorry I don't have better news. Hopefully the hospital will be willing to work out a payment plan with you.
The new insurance obviously isn't going to pay because neither you nor the baby were covered with them at the time of the birth/hospital stay.
Answer
I concur with the above but with one caveat: in SOME states an insurance carrier is required to carry the newborn child of an insured for up to 30 days whether or not they have been formally added to the plan. The ONLY way I can see you getting the old insurance to pay is if your state has such a provision. You will have to ask your state insurance commissioner if that is the case. The fact that you were leaving in 30 days did not stop you from adding the baby to the plan.
There are no circumstances whatsoever in which your new employer's insurance will pay.
Answer
I agree with CBG 100%, but add one more caveat...some state law will not always 100% apply to self-funded ERISA plans. Self-funded plans are federally guided as opposed to state. I always caution one to be aware of self-funded status. If you aren't aware of self-funded vs. fully insured, specifically ask your employer.
Answer
Jezziebelle is correct that self-funded plans are subject to the Federal ERISA and not necessarily to state law. However, there is nothing in ERISA that will require the insurance carrier to pay for a newborn that was not added to the policy. The ONLY way the old carrier is going to pay is if, as I said, there is a state law that requires them to do so. If they are not subject to state law, you're out of luck before you start. If they are subject to state law, they STILL only have to pay if the state law SPECIFICALLY grants coverage to newborns for the first 30 days. There is nothing in Federal law that is going to help you.