My Insurance Nightmare

I'm living an insurance nightmare. When the girls were born, both Robin and I had insurance through our respective employers. Because I was planning to take a leave of absence from my job (and hence lose my benefits), we were going to add the girls to Robin's policy. That decision has started us on a path that feels like a dog chasing its tail. I haven't seen all of the bills yet, but I'm sure you're wondering how much it costs to have intensive pre-natal care, be hospitalized for 11 days, give birth via c-section, stay in the hospital for 4 more days AND have 3 girls in the NICU for 59, 63 and 70 days. Based upon what I have seen, I'm estimating the final cost to be approximately $1,750,000.

When babies are born, they are automatically "covered" under the mother's insurance policy for the first 30 days. They do not need to be "added" to the plan, but if they are not added then coverage ends after that 30 day period. Simple enough, and I was fully aware of this fact. However, I thought we could just deny that coverage and add them to Robin's policy. As soon as I could, I gave all of the providers Robin's insurance information. Only one provider followed through and billed Robin's insurance. I wish they would not have done that.....

After much run around, I have discovered that there is this little known (or at least not known to me and my first job out of law school was in-house counsel for an health insurance company) law called the "birthday rule." Insurance companies live for denying coverage. This fact I know first hand from my first job. In order to keep them from arguing about which one is primary when both a mother and a father have coverage, they apply the birthday rule which states that whichever parent's birthday comes first in the calendar year is the primary insurance. Well, that's me. So, now we know that the girls must be covered by my insurance, as primary, for the first 30 days and Robin's insurance is secondary. After the 30 day period, Robin's insurance is primary.

This is all fine and dandy, BUT because we didn't "add" the girls to my policy they are added as BG (baby girl). So, now my insurance company is getting three bills for the same service for BG (probably somewhere on the bill it says BG1 or 2 or 3). They think they are being billed in triplicate, and they deny two of the claims. I continue to call and explain the situation to them, but they can't include the girls' names unless we "add" them. FINALLY, someone who is trying to collect money (the doctor), gets their insurance rep to add the girls' names, which fixed that problem on that end.

Next problem - when we added the girls to Robin's plan, I put down that they did not have any other coverage because I was not aware of the "birthday rule." They paid approximately $250,000 in claims (from the aforementioned NICU doctor) as primary, when they should have been secondary. Ugh. Now Robin's insurance is all pissed off. They are holding all claims as "pending" until they can get information from my insurance company about coverage dates. I received a 2 inch thick packet of "overpayment letters" regarding these claims. I have sent them the prior coverage information twice now, but it is still being held. Meanwhile, providers are getting angry and sending me bills. Ugh, ugh, ugh.....

I think I'm really close to solving this nightmare of a problem, but seriously, do they think I have all the time in the world to spend on the phone arguing with customer service reps who refuse to transfer me to someone who can actually help me?

Currently, all of our unpaid claims are being held by Robin's insurance company in the "large claims" department. I'm trying my hardest to get them released, but seriously...what a nightmare.....

Wish me luck.