Do insurance companies pay for hospital stays if coverage stops while in hospital?

Question

My wife is pregnant and going to deliver March 30th. She was fired from her job on the 1st and got to keep her coverage thru the 31st. Since we will be in the hospital for 4 days but wont get out until the 2nd of April, does the insurance company have to pay for those 2 days when coverage really lapsed? Since we're going in before coverage has stopped are they responsible?

Answer 1

It depends on the plan. Some plans - like Aetna - will cover if the plan terms in the middle of the hospital stay - it's called "Continuity of Care". Other plans, like Oxford, do not. You should call the member services number on your card and ask them what is specific to your plan.

Answer 2

This answer will vary by state and by the funding status of the group policy (i.e. whether it's a self-funded ERISA plan or a fully-insured plan). Folks here who answer yes or no cannot know what your policy says. The best thing for you to do is read the Certificate of Coverage given to her when she was enrolled (her employer should have extra copies of you no longer have this document). Read the section titled "Individual Terminations" (or something like that -- they're called different things). It will explain what happens in this situation.

For example, in my state, it's the law that an insurer continue to cover the hospitalization until the person is discharged AND a premium cannot be assessed.

If you want to extend the coverage beyond her discharge, she should elect COBRA. Don't forget to add the child -- it's not automatic.

Answer 3

It very easy, if the coverage is until 31st, then the insurance company will only cover it until 31st. The rest of expenses on 1st and 2nd of April you going to paid your self. Remember keep the receite and go back to your wife company to claim back the money where you had use on 30th and 31th. If you want to claim more, you may try to request doctor write the reciete for operation and medical fees by before 31st.

Answer 4

They will cover the 30th and the 31st only. But as the above answer said, under COBRA you can keep your coverage as long as you pay the premium yourself. With her being pregnant, she should have done the paperwork for it as soon as she was fired.

I assume your wife is having a C-section or being induced since you give a specific date. With a C-section, you don't have much choice, but with induction, if everything is normal, your wife could ask to be released early. Most everyone I know who had normal deliveries only spent two nights in the hospital.

Answer 5

They can stop the coverage but by LAW you are entitled to COBRA benefits. Under COBRA you can keep your insurance for up to 18 months by paying 102% of the premium the employer paid. (the 2% is for administration fees). You should receive notification from the employer. You have 60 days from date coverage ends to "choose" your coverage and another 45 days to make the payment. They will "suspend" your coverage until the payment is received and then go back and pay those bills.

Answer 6

I would say no,because you already know
The termination date which is 31st of March ,2007.