Mother's or Father's Insurance for Newborn

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Kaizen Soze
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Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Tue May 26, 2020 5:19 pm

Our bundle of joy came a few weeks early and our brains are mush from sleep deprivation, so I'd like to lean on the forum's wisdom in help selecting the appropriate short-term and long-term insurance plan(s) for our new family.

Insurance Comparison (annual cost):
https://imgur.com/QUf3zsK

Key Points:
  • The labor was only 1.5hrs at the hospital with no time for any pain meds. And then recovery was 30hrs. before we were discharged.
  • Mother and Father are currently on individual insurance plans through their employers.
  • Mother doesn't want to be on a high deductible plan because she visits doctors more frequently (OBGYN, chiropractor, dermatologist, etc.). Father has benefited from being on a high deductible plan, maxes out HSA.
  • Mother's insurance coverage cycle has recently changed to 13 months, May 2020 through June 2021. (teacher)
  • Mother's insurance confirmed that if Bambino is added to Mother's insurance, the entire hospital bill would be $1.5k (individual deductible) and then future visits would go towards the family deductible.
  • Mother, Father, and Bambino are healthy.
Short-term Questions:
  1. Do hospitals typically bill the entire labor/delivery/recovery to the Mother's insurance and then future visits to Bambino? Is it the hospital or insurance company that determines who gets billed for what?
  2. I plan on calling the hospital to see how they will bill and calling each insurance company to see how they cover labor/delivery/recovery/future visits. What important questions do I need to ask or what else should we do? We just had our 48hr. pediatrician visit and the doctor said there's usually no cost for all the check-ups (48hrs, 1wk, 2wk, 1mo, 2mo, 4mo, 6mo, 9mo, 12mo).
Long-term Questions:
  1. If added to Mother's insurance to take advantage of the $1.5k total cost, is it possible to switch to Father's insurance during the enrollment period? It sounds problematic to enroll/switch Bambino to Father's insurance and then overlap 6 months of coverage since the coverage cycles are not the same. Not sure how that works.
  2. If adding Bambino to Mother's insurance, would the $3k annual increase in cost, compared to adding to Father's CCP for $1.5k, be offset by the better coverage? How much should we expect to spend on newborn medical bills? Basically, which plan(s) should we choose?
Thanks in advance, I hope the post is coherent.

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Picasso
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Re: Mother's or Father's Insurance for Newborn

Post by Picasso » Tue May 26, 2020 5:43 pm

I work in the industry and was just researching a portion of this for our plan today. On our HDHP plan design, for pregnancy, the pre-natal visits (excluding lab and imaging), delivery, and post-natal visits are billed as a single bundled charge after the hospital visit for delivery itself. This applies to in-network providers only since out-of-network providers hit a different accumulator.

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Picasso
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Re: Mother's or Father's Insurance for Newborn

Post by Picasso » Tue May 26, 2020 5:48 pm

One more: federal insurance regulations require that the mother’s health insurance cover a newborn for up to 30 days, after which the child will need to be listed as an individual on whichever plan you choose.

I believe the visits for that child that are not post-natal care as dictated by your insurance and are greater that 30 days after birth will be billed as individual pediatric visits to the child’s insurance member ID.

Topic Author
Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Tue May 26, 2020 5:57 pm

Picasso wrote:
Tue May 26, 2020 5:48 pm
One more: federal insurance regulations require that the mother’s health insurance cover a newborn for up to 30 days, after which the child will need to be listed as an individual on whichever plan you choose.

I believe the visits for that child that are not post-natal care as dictated by your insurance and are greater that 30 days after birth will be billed as individual pediatric visits to the child’s insurance member ID.
Ah, I thought that whichever plan I would choose within the next 30 days would retroactively apply to Bambino since birth, not that coverage would start at greater than 30 days after birth if we switched plans.

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Nate79
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Re: Mother's or Father's Insurance for Newborn

Post by Nate79 » Tue May 26, 2020 6:00 pm

You really need to talk to your insurance company and hospital and doctors office if you care to get this much detail ahead of time. In our case all expenses after birth were assigned to the individual (mother or baby) for which the line item care was performed. It was not lump sum.

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Picasso
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Re: Mother's or Father's Insurance for Newborn

Post by Picasso » Tue May 26, 2020 6:04 pm

That scenario may be a custom feature of a very high-end plan design, but I’ve never seen it.

For what it’s worth, I’d put Child 1 on the mother’s PPO. ER visits for children are common and would be less expensive to you.

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Watty
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Re: Mother's or Father's Insurance for Newborn

Post by Watty » Tue May 26, 2020 6:12 pm

Something to look into is the "birthday rule" (Google this) to see if or how it applies in your situation. This may vary by insurance company and state laws.

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Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Wed May 27, 2020 3:28 pm

Update: Spoke to the hospital and both insurance companies.

Bambino is required to be on Mother's insurance for the first 30 days. If we decide to add him to Father's plan, the effective date would be 30 days after birth.
The bill for delivery (no pain meds) and 1 night recovery will be $21k for Mother and $2.5k for Bambino (yikes). Contradicting our earliest understanding, the account for Bambino starts at birth so the $2.5k is charged to his account and applied to his $1.5k deductible.
If we switched plans in the future (after the 30 day float period), the "birthday rule" would be in affect while we paid 6 months of premiums for both plans.

So given that Bambino will be on Mother's insurance for the first 30 days and switching down the road would be very expensive with 6 months of premium overlap, which is the best long-term plan for Bambino after 30 days?

Insurance Comparison (annual cost):
https://imgur.com/QUf3zsK

seawolf21
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Re: Mother's or Father's Insurance for Newborn

Post by seawolf21 » Thu May 28, 2020 12:34 am

“birthday rule” is part of “coordination of benefits.”

seawolf21
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Re: Mother's or Father's Insurance for Newborn

Post by seawolf21 » Thu May 28, 2020 12:39 am

Kaizen Soze wrote:
Wed May 27, 2020 3:28 pm
Update: Spoke to the hospital and both insurance companies.

Bambino is required to be on Mother's insurance for the first 30 days. If we decide to add him to Father's plan, the effective date would be 30 days after birth.
The bill for delivery (no pain meds) and 1 night recovery will be $21k for Mother and $2.5k for Bambino (yikes). Contradicting our earliest understanding, the account for Bambino starts at birth so the $2.5k is charged to his account and applied to his $1.5k deductible.
If we switched plans in the future (after the 30 day float period), the "birthday rule" would be in affect while we paid 6 months of premiums for both plans.

So given that Bambino will be on Mother's insurance for the first 30 days and switching down the road would be very expensive with 6 months of premium overlap, which is the best long-term plan for Bambino after 30 days?

Insurance Comparison (annual cost):
https://imgur.com/QUf3zsK
“birthday rule” is part of “coordination of benefits.”

I’m confused about premium overlap. Why can’t you take the child off mom’s plan after 30 days? “Gaining coverage” on dad’s plan should be a qualifying event allowing for the child to be removed from mom’s plan. It should be no different than if dad had switch jobs or had open enrollment right around the time the child is 4 weeks old.

Topic Author
Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Thu May 28, 2020 6:00 am

seawolf21 wrote:
Thu May 28, 2020 12:39 am
Kaizen Soze wrote:
Wed May 27, 2020 3:28 pm
Update: Spoke to the hospital and both insurance companies.

Bambino is required to be on Mother's insurance for the first 30 days. If we decide to add him to Father's plan, the effective date would be 30 days after birth.
The bill for delivery (no pain meds) and 1 night recovery will be $21k for Mother and $2.5k for Bambino (yikes). Contradicting our earliest understanding, the account for Bambino starts at birth so the $2.5k is charged to his account and applied to his $1.5k deductible.
If we switched plans in the future (after the 30 day float period), the "birthday rule" would be in affect while we paid 6 months of premiums for both plans.

So given that Bambino will be on Mother's insurance for the first 30 days and switching down the road would be very expensive with 6 months of premium overlap, which is the best long-term plan for Bambino after 30 days?

Insurance Comparison (annual cost):
https://imgur.com/QUf3zsK
I’m confused about premium overlap. Why can’t you take the child off mom’s plan after 30 days? “Gaining coverage” on dad’s plan should be a qualifying event allowing for the child to be removed from mom’s plan. It should be no different than if dad had switch jobs or had open enrollment right around the time the child is 4 weeks old.
According to the conversations I had with both insurance companies, after the initial 30 days I'd have to wait until open enrollment to add/remove. I couldn't gain coverage without having another qualifying event.

Which is the better plan after the initial 30 days? Continue with mom's PPO+ or switch to dad's CCP? I guess the root of the question is, is it worth an extra $1.5k in premiums (and keep HSA contribution at $3.55k) for better coverage on a newborn?

Oops, the choices were calculated using the PPO option instead of PPO+, so the additional premiums over the CCP plan would be $2k.

motorcyclesarecool
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Re: Mother's or Father's Insurance for Newborn

Post by motorcyclesarecool » Thu May 28, 2020 6:24 am

If mother and father are married, you need to be careful to ensure mother’s health insurance doesn’t include an FSA that could impede father’s ability to make HSA contributions.

I’d leave things as they are for now, but the next open season, gather all your EOBs, drop the numbers into a spreadsheet. Determine whether the total annual outlay including premiums, prenatal, and childbirth related expenses would have been more or less under your HDHP. All things being equal it would be advantageous to be able to contribute the full Family amount to your HSA. If you can show your partner that the total outlay including tax savings would have been lower, it could be a win-win.
Understand that choosing an HDHP is very much a "red pill" approach. Most would rather pay higher premiums for a $20 copay per visit. They will think you weird for choosing an HSA.

dukeblue219
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Re: Mother's or Father's Insurance for Newborn

Post by dukeblue219 » Thu May 28, 2020 6:53 am

A bit of unsolicited advice: don't spend your spare time trying to maximize the tax savings, on the phone with everyone, or minimizing insurance spending to the dollar. As long as mom has good PPO insurance keep the kid over there. Figure out if it's truly optimal at the next open enrollment. You have enough to do already!

Also, congratulations!

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Watty
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Re: Mother's or Father's Insurance for Newborn

Post by Watty » Thu May 28, 2020 8:12 am

A couple of things to keep in mind;

1) Your wife's plan may have a family deductible.

2) If you change the kid to your plan after 30 days then the the kid will have a new 2020 deductible under your plan.

3) If the kid is under your plan then you may need to change the kids doctors to ones under your plan.

4) If you try to have the kid under both plans then you may end up using doctors that are in network in one plan but out of network in the other plan. Dealing with one insurance company is often difficult but if you have two then there will be a lot of finger pointing between two the two companies with each of them saying the other should pay. Some procedures may require the insurance companies preapproval and you will need to get the preapproval from both companies.

FreemanB
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Re: Mother's or Father's Insurance for Newborn

Post by FreemanB » Thu May 28, 2020 8:39 am

Kaizen Soze wrote:
Wed May 27, 2020 3:28 pm
Bambino is required to be on Mother's insurance for the first 30 days. If we decide to add him to Father's plan, the effective date would be 30 days after birth.
Did you get this from all of them? I've never heard of newborn insurance working like this. Everything I've ever seen or heard states that you have 30 days to enroll the newborn in a parent's insurance plan, which will then provide coverage retroactively. When my wife had our baby, we enrolled her under my plan, not my wife's.(Everything related to the delivery was covered under my wife, but everything afterwards that wasn't was billed to my insurance) I think the hospital will generally assume the baby will have the same insurance as the mother until they are told otherwise, but it doesn't sound right that you don't even have to enroll them for the first month. I would definitely verify this by finding the plan documentation in writing. Never trust what insurance company reps tell you on the phone, since you can call three times and get three different answers, none of which are actually correct.

In your case though, I'd probably stick with the Mother's plan for now, and as other's suggested, evaluate it during open enrollment.

Topic Author
Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Thu May 28, 2020 8:59 am

motorcyclesarecool wrote:
Thu May 28, 2020 6:24 am
If mother and father are married, you need to be careful to ensure mother’s health insurance doesn’t include an FSA that could impede father’s ability to make HSA contributions.
This is a good point. We got married last year and I realized we couldn't do this so she stopped her FSA for 2020.

Topic Author
Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Thu May 28, 2020 9:03 am

dukeblue219 wrote:
Thu May 28, 2020 6:53 am
A bit of unsolicited advice: don't spend your spare time trying to maximize the tax savings, on the phone with everyone, or minimizing insurance spending to the dollar. As long as mom has good PPO insurance keep the kid over there. Figure out if it's truly optimal at the next open enrollment. You have enough to do already!

Also, congratulations!
Your advice is welcome. I would definitely follow this advice if we were on the same coverage cycles. She's a teacher and her next enrollment is around April while mine is in November. So if we switched plans we'd be paying family premiums on two plans for 6 months.

Topic Author
Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Thu May 28, 2020 9:07 am

Watty wrote:
Thu May 28, 2020 8:12 am
A couple of things to keep in mind;

1) Your wife's plan may have a family deductible.

2) If you change the kid to your plan after 30 days then the the kid will have a new 2020 deductible under your plan.

3) If the kid is under your plan then you may need to change the kids doctors to ones under your plan.

4) If you try to have the kid under both plans then you may end up using doctors that are in network in one plan but out of network in the other plan. Dealing with one insurance company is often difficult but if you have two then there will be a lot of finger pointing between two the two companies with each of them saying the other should pay. Some procedures may require the insurance companies preapproval and you will need to get the preapproval from both companies.
1. Wife and baby have separate deductibles, $1.5k each. (confirmed w/ insurance)
2. Correct
3. Our hospital and pediatrician accepts both our insurances.
4. "Birthday rule" becomes in affect. If baby is covered by both plans then wife's plan is primary because her birthday is earlier than mine. (confirmed w/ insurance)

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Kaizen Soze
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Re: Mother's or Father's Insurance for Newborn

Post by Kaizen Soze » Thu May 28, 2020 9:16 am

FreemanB wrote:
Thu May 28, 2020 8:39 am
Kaizen Soze wrote:
Wed May 27, 2020 3:28 pm
Bambino is required to be on Mother's insurance for the first 30 days. If we decide to add him to Father's plan, the effective date would be 30 days after birth.
Did you get this from all of them? I've never heard of newborn insurance working like this. Everything I've ever seen or heard states that you have 30 days to enroll the newborn in a parent's insurance plan, which will then provide coverage retroactively. When my wife had our baby, we enrolled her under my plan, not my wife's.(Everything related to the delivery was covered under my wife, but everything afterwards that wasn't was billed to my insurance) I think the hospital will generally assume the baby will have the same insurance as the mother until they are told otherwise, but it doesn't sound right that you don't even have to enroll them for the first month. I would definitely verify this by finding the plan documentation in writing. Never trust what insurance company reps tell you on the phone, since you can call three times and get three different answers, none of which are actually correct.

In your case though, I'd probably stick with the Mother's plan for now, and as other's suggested, evaluate it during open enrollment.
The insurance rep said that under the rules of my plan, if the mother has her own plan the baby is required to be under her plan for the first 30 days. If we made the switch today it wouldn't be in effect until 30 days after birth. The rep said it wasn't an option to add baby and cover baby's hospital bill under my plan. But you're right, I've had reps give me the wrong answer before. I should verify through the plan documentation.

It would cost us $1.5k to switch to my plan during my open enrollment due to the overlap in coverage cycles.

targetconfusion
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Re: Mother's or Father's Insurance for Newborn

Post by targetconfusion » Thu May 28, 2020 9:27 am

FreemanB wrote:
Thu May 28, 2020 8:39 am
Kaizen Soze wrote:
Wed May 27, 2020 3:28 pm
Bambino is required to be on Mother's insurance for the first 30 days. If we decide to add him to Father's plan, the effective date would be 30 days after birth.
Did you get this from all of them? I've never heard of newborn insurance working like this. Everything I've ever seen or heard states that you have 30 days to enroll the newborn in a parent's insurance plan, which will then provide coverage retroactively. When my wife had our baby, we enrolled her under my plan, not my wife's.(Everything related to the delivery was covered under my wife, but everything afterwards that wasn't was billed to my insurance) I think the hospital will generally assume the baby will have the same insurance as the mother until they are told otherwise, but it doesn't sound right that you don't even have to enroll them for the first month. I would definitely verify this by finding the plan documentation in writing. Never trust what insurance company reps tell you on the phone, since you can call three times and get three different answers, none of which are actually correct.
In your case though, I'd probably stick with the Mother's plan for now, and as other's suggested, evaluate it during open enrollment.
1. I was in this precise situation and it was counterintuitive. The bottom line, as others have said, is that you have to see what your specific plan's rules are. I'd second Freeman's skepticism of anything phone reps tell you. It's unfortunate but unless you want to get into recording calls, which is its own hassle and questionably legal in areas, you have to just learn the plan documents. Move to email, if possible, and then write something to "confirm your understanding" of a section that you attach.

2. Re: whose insurance covers who, we ran into this precise snafu. On our plan, anyway, I was surprised to discover the insurer absorbing perinatal infant expenses on the mother's plan. I had enrolled the newborn on my (father's) plan and there was nothing to indicate this would happen. It worked against us, deductiblewise (without getting into details that don't matter). We'd have to pay either way, but it made sense for us to keep the infant on my family plan and have the charges there count toward *that* deductible and out-of-pocket max. The plan basically said, somewhere, that a newborn's perinatal (maybe it was within 30 days, I can't remember) charges *could* be applied to the mother's individual plan. My counterargument was that just because that was permitted doesn't mean it was required if the infant was also covered under its own plan. Standard operating procedure is that charges for Patient A count against Patient A's insurance. So I argued that because the infant had coverage (retroactively applied, of course) from birth and this coverage should be billed for infant's charges. Insurer kept citing the "infant can be on mother's" clause as though I was unable to understand it. We went in circles. The reps I dealt with were a combination of not very bright and not very motivated to consider anything other than what they'd be programmed to follow. Linguistic nuance was utterly lost on them. You can always escalate and make noise but it quickly reached my "not worth it" threshold and I moved on with my life. As you are now, my brain was sleep deprived and being pulled in fourteen other directions and in retrospect it was the right move.

Not that your experience or preferences mirror mine, but having walked a similar path my recommendation is to go with the insurer's flow. If they're biased toward sticking perinatal infant charges on the mom's plan, I'd suggest being corresponding biased toward keeping the newborn on her insurance for the first year to keep credit toward deductible. An exception could be if your insurance is much better, feature-wise, or if your deductible is going to be soaked up by other known things and it won't matter. I would suggest, for planning, purposes, expecting other infant expenses during the first year. I think we've been in the emergency department 4 times in the first two years for unrelated and unforeseeable things (e.g., a hair tourniquet where a hair gets wrapped around a baby's (in this case) toe. Financially speaking, they're volatile. If my past is anything like your prologue, I'd lean toward keeping Bambino on mom's plan (especially if better) for year 1 and even probably for year 2, even if it goes against your instinct (as it did mine) to create extra HSA contribution space on your plan by moving Bambino there.

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