Stupid health insurance

[Ken]

Or you could just answer the question, but that seems to be out of the question.

She called her insurance and they said the baby was covered. However she didn't go to the website to register the child until 39 days after birth (instead of 31) so the insurance used that loophole to avoid covering the child (which was very expensive due to NICU care)

[The Feral Slasher]

She called her insurance and they said the baby was covered. However she didn't go to the website to register the child until 39 days after birth (instead of 31) so the insurance used that loophole to avoid covering the child (which was very expensive due to NICU care)

And denied her two appeals until they were publicly shamed

[Hornsby]

Thank you...now I know, and you get the pleasure of informing me. And Ken gets extra credit for being a good guy and filling in the gaps. Winner, winner!

[Ken]

Thank you...now I know, and you get the pleasure of informing me. And Ken gets extra credit for being a good guy and filling in the gaps. Winner, winner!

I prefer half credit

[umjewman]

I prefer half credit

I disagree.

[GwynnInTheHall]

I prefer half credit

Half a point is sometimes all you need to win...........

[Sour Masher]

We had a similar thing happen to us with our first child, though not as extreme. He was 6 weeks early and all our plans went out the window. We had to go to a different hospital than we had planned, because the one we wanted to go to did not have a NICU. Luckily, I remembered to call them while my wife was in labor, so I thought we were in the clear. But he had to go to the NICU for a couple of weeks after, and luckily again, I called and made sure we were covered. But even though I thought we had covered all of our bases, we got a bill for over 3k, because the NICU doctor on staff (and the one who performed the circumcision, even after we had expressed we wanted my wife's doctor to do it) was out of network. We had no choice in the matter. I was able to talk to hospital admins to get the NICU fees cut in half, so we ended up spending $1500 that we did not anticipate after, we thought, getting everything lined up the best we could. It would have ended up much, much worse for us if I did not think to call the insurance company about the last minute emergency switch is hospital, and they still played 20 questions with me about it.

[Sour Masher]

On a related note, one thing I learned when I worked in patient accounts of a hospital while in high school was that cash payers could negotiate lower than billed payments, because billed amounts are often inflated (this is for the hospital part of the bill, not the doctor part). It is a game hospitals play with insurance providers, or at least it used to be that way. They have to pad the bill, because big insurance companies are going to negotiate down. I also learned that the hospital would make a different amount of money for the same procedure from different insurance companies, and one, Avmed, I think, somehow negotiated a simple flat rate payment for just about any procedure, and it worked out that some procedures that took 15 minutes, like a cataract surgery, would be a huge money maker for the hospital, while others, like a 4 hour knee surgery, would actually end up costing the hospital more than the payment. But it all evened out to profit, so they rolled with it. I know they preferred the fast procedures to be booked, but I don't think they gamed that, as I imagine it would have been caught and ended poorly for them. All this may have changed, as this was over 25 years ago.