newborn baby..insurance question?

Question

I had my baby on august 21st . I submitted my paperwork to my employer to add her as a dependent to my benefits within the 30 days well something happened apparently on their end and they didn't get it in in time so I apparently have to wait til open enrollment to cover her. Needless to say I am extremely upset over this so a few questions, when is open enrollment generally and I have to take my daughter in 2 weeks for her shots, how much do they run and how much are dr visits since I will be paying out of pocket for these visits?..thanks for your comments. I am still fighting for them to add her since this was not my fault. Can they still add her?

Answer 1

If you did your part getting the paperwork to the employer within 30 days, they should be able to work with the insurer to get your baby added.

I previously worked for a very large health insurer. We would frequently receive requests from employers who made mistakes in paperwork (through no fault of the employee), and the dependents were always added. (I don't know whether the employer was charged extra for that service - I didn't work in premium billing. But either way, the dependents were still added despite the fact that the employer screwed up.)

Do you have proof that you submited the paperwork to the employer within 30 days? If so, I would definitely fight it.

In the meantime, yes - the newborn vaccines can be quite pricey out of pocket. You may want to check with the pediatrician to see if they negotiate a self-pay discount with patients, or else see if you can get the vaccines at a reduced rate from the local health department.

Answer 2

The insurance should be adding her by now. Sometimes they want the birth certificate and baby's SSN before they're "offically" added, which can be 6-8 weeks, but you should NOT have to wait until open enrollment. Start with your HR person. They should be able to help advocate for you. File a complaint in writing to the insurance company. They can pull the original application to add the baby and see the date it was filed. You may need to escalate it as far as your state insurance board, but if your HR people help you, you may not. If your HR people screwed up, then they need to recify it right away.

Open enrollment varies by company. Sometimes it's the first of the year, sometimes it's the beginning of their fiscal year, which can be any time.

Paying out of pocket for vaccines is expensive. My office charges $480 for an infant well exam and the three vaccines given (which are the Pediarix, Hib, and Prevnar, which are $135, $90, and $115, respectively. Plus $140 for the exam.) Now, that said, New York State has a program called Vaccines for Children (VFC) - the state provides the vaccines (because they buy such large quantities from the manufacturers, they get a HUGE discount) and the doctor's offices can give them to underinsured or uninsured patients under 18 years old for $17.85 each. Combine that with a discount for the exam, and the bill would be $165.55. SO, see if your state has a program like that - call the doctor's office and ask. If not, there is no medical harm in delaying vaccines, but as someone else said, you just need to limit contact with others.

If your insurance digs in their heels and refuses to add your baby until open enrollement, until you get the decision overturned, see if your state has a CHiPs program - it's low-cost or free insurance for children. In New York, it's called Child Health Plus. (The premiums are like $25 a month or something like that for full coverage, including dental.)

Answer 3

Even if they can't ADD her, they should be on the hook for the coverage - it's called Employment Benefits Liability coverage. As long as you got the paperwork in within the 30 days, any resulting NON ADDING is their fault, not yours. And the EMPLOYER needs to call the insurance company to get her added, OR pay the bills - because they aren't covered due to THEIR fault. ANY COURT will see it that way, but obviously, you don't want to have to really sue them, or you'll lose your job.

Obviously, you can't even add the baby until you have her social security number, which takes several weeks if you're LUCKY. So they should have jumped on this.

Regarding those shots and the early tests - my LAST baby, took two months to add to the insurance, so I had to pay for several checkups out of pocket. One was almost $400, with "mandatory" shots. The checkup alone was $122. It did eventually get reimbursed.

You can ALWAYS delay getting the shots a few months, it won't hurt anything, if you're careful with not exposing your baby to a lot of people.

But open enrollment, if your company uses a January 1st date for insurance, is usually in November.

Congrats on the baby, by the way - my daughter was born two days after yours. So we're probably on the same "lack of sleep" wavelength.

Answer 4

Open enrollment is either due to a change in family - a baby in your case or once a year - I believe the time varies depending on where you work or what insurance you have. That is my experience.

If you have proof that it was the employer's fault they should pay for the costs you incur - but they likely won't want to. Check when enrollment is with your HR dept. Mine was this past Sept. If you have to go a year with out you may be liable for some big expenses. I'm sure your baby is fine but my little girl was hospitalized soon after she was born the total cost was about $45,000 for the year.

Answer 5

I would definitely continue to fight to have her added. If you submitted the paperwork on time, yes, they can still add her. They can do anything they want to. Work with you company's benefits department as well as the insurance company.
Open enrollment periods vary. Many are at the beginning of the calendar year or near the end of the year, but not all....my husband's is in October.
As for shots, they will be pricey out-of-pocket. See if you can get them cheaper/free at the health dept. or clinic. There may be some vaccines you can put off a while until you get your insurance straightened out (I am no expert and you should consult your pediatrician on that).
Best of luck to you! Insurance companies are evil!

Answer 6

This is totally BS..... Fight this until you win....Why should you pay for someone elses incompetence. In the mean time, in the event your baby becomes ill, explore an individual policy. Costs vary by market, but in my market, a baby would run less than $100 per month....

Another thing to think about, is that if this is your first, the change in your costs to add your child to your employers plan might be more than the individual plan....

If this is the case, then it might be in your best interest to let it go....

You can go on to Ehealthinsurance.com to look at rates for the baby, then compare it to your company's cost. You can then discuss with an independent agent in your area. Please feel free to email me with any questions. I am more than willing to help you look at your options as an impartial third party....

Answer 7

how about gathering the bill for your baby. and then negociate your employer to pay for that instead of you.