I-Team: New parents’ insurance woes are piling up thanks to different policies.

Because they had two different health insurance policies, Chris and Lauren Lewis did not have to worry about the cost of having their son, Langston, delivered at a hospital.

The good news is that I was covered by insurance. Chris Lewis assured me that we were “double covered” because my wife had insurance.

However, the Lewises quickly learned that having two insurance plans was often more cumbersome than having none at all.

The Lewises were surprised to receive a bill for $4,160 from Baylor Scott & White Hospital fourteen months after Langston was born.

The Lewises were told by the hospital that neither of their insurance companies would cover the cost of their care, even though they had tried for a year.

It doesn’t make any sense, and we were thinking, “Are we going to have to pay out of pocket for this cost?” A Quote from Chris Lewis

Often, it’s not clear which of the parents’ health insurance policies will cover their newborn.

According to Sabrina Corlette, J.D., co-founder and director of Georgetown University’s Center on Health Insurance Reforms, “When this happens, it offers an opportunity for each insurance company to cast the finger at the other.” “And the patient or consumer, more often than not, falls through the cracks and gets left with the bill.”

United Healthcare provided coverage for Lauren Lewis. In a statement to CBS 11 News, the insurance firm said it applies the “birthday rule” when both parents have their own policies. The rule says that the insurance of the parent whose birthday is earlier in the year will cover the birth of the child.

As a representative from United Healthcare said to CBS 11 News, “Since Mr. Lewis’ birthday occurs before Mrs. Lewis’ birthday in the calendar year, the hospital bill for their child should be covered by Mr. Lewis’ insurance. We are helping his insurance company hash out the details of this medical cost. “

The National Association of Insurance Commissioners established the “birthday rule” methodology to resolve coordination of benefits issues between insurers.

About fifteen percent of Texans are covered by state-regulated health plans that are bound by the “birthday rule” provisions of the Texas Insurance Code.

There is no federal law that says which insurance coverage applies to a birth when both parents are individually covered, but the U.S. Department of Labor regulates most employer-sponsored health plans held by Texans (38%).

For Chris Lewis’s insurance, this was the situation. CareFirst BlueChoice manages his company’s insurance coverage. Given that the Lewises have separate insurance policies, CareFirst BlueChoice informed them that the insurance policy of the mother would be liable for paying for the birth.

CBS 11 News reached out to CareFirst BlueChoice, but did not receive a response. The Dallas couple claimed they heard from Baylor Scott and White after CBS 11 News contacted Lewis’ insurance providers. A hospital employee assured the family that they would be able to pay their payment because the hospital had escalated the matter and was working with CareFirst BlueChoice.

In a statement to CBS 11 News, the hospital said, “We understand and empathize with the complications patients experience at times, and we are working directly with (the Lewises) to help and find resolution.”

According to Corlette, the reason why disagreements arise over the coordination of benefits is that not all insurance plans are subject to the same rules or even government oversight. Government health plans such as Medicaid, Medicare, and military plans are regulated by the U.S. Department of Health and Human Services; fully funded state insurance plans in Texas are supervised by the Texas Department of Insurance; and most self-funded employer-sponsored plans are supervised by the U.S. Department of Labor.

The American health care system is “extremely fragmented,” as Corlette put it. The customer is nearly always responsible for figuring out how to use the system, and making a mistake can have serious consequences.

The Empowering Parents’ Healthcare Choice Act was introduced in July of 2021 by federal politicians. With this legislation in place, parents who are enrolled in both medical and dental insurance programs would be able to designate one as their primary coverage. The bill is being discussed under the House Health Subcommittee.

“Welcoming a kid into your family should be a joyful event, free from excessive stress and financial burden from insurance companies,” said U.S. Rep. Sharice Davids (D-Kansas), who wrote the bill. It’s a quick fix that empowers parents to make an educated decision regarding their family’s healthcare coverage.

However, not all medical coverage would be covered by the law even if the measure were to become law. This federal legislation would only affect federally regulated plans.

If you live in Texas and are experiencing trouble coordinating benefits with your health insurance, you can call the Texas Department of Insurance’s helpline at 1-800-252-3439.

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