Last week, I got a note from Lisa, who works in a global technology company based in Andover. The subject line of her message was: "2 Insurance Policies, No One Will Pay." Here's her story:
When Lisa and her husband Mark got married a few years back, they each had their own separate insurance plans: she was covered by what she calls Blue Cross Blue Shield of New York (even though she lives and works in Massachusetts) and he had Tufts Health Plan. They were fine with what they had and never bothered to switch.
But when their first child was born in October, they quickly realized they'd better put the newborn on one or the other parent's health insurance. Within 10 days after the little girl was born, they signed her on to her father's Tufts plan. (Lisa was planning to join this new family plan as soon as the open enrollment period rolled around.)
Everything seemed to be going fine. Tufts covered the child's pediatric appointments no problem, Lisa said. Then in early summer, the couple got a bill for $4,000 from the hospital. After numerous calls, this is what they found out: both insurance companies had refused to pay the bill.
Blue Cross wouldn't pay for the baby's care, but Lisa said Tufts told the couple that it is "standard practice" that a new baby is added to her mother's insurance plan.
"Well if it is standard practice," writes Lisa. "Why didn’t Tufts mention this when we added the baby to the policy? It is pretty obvious that her father (Mark) is the only other person on the policy." Lisa says she and her husband have spent countless hours and between 20 and 30 phone calls trying to fix the problem. This on top of a new baby and a full-time job. "The thing that irks me the most," writes Lisa. "is that if anything, we are OVER Insured with both of us paying the cost of 2 policies… and yet no one will cover this cost? If I had given birth with no insurance at all the state would probably pay for it and I would never even see a bill. Instead I am being penalized for a random internal insurance practice that I was never made aware of."
When things like this happen, it usually doesn't hurt to contact a reporter.
I called Tufts, and spokesperson Patti Embry-Tautenhan told me that indeed, per the Massachusetts Division of Insurance, a hospital is obligated to bill and the insurer is obligated to pay "well newborn nursery charges" (that is, inpatient care for the mother and newborn for at least 48 hours after birth) under the mother's insurance because those charges are rolled up as "maternity benefits." However, Patti said those benefits don't include the actual delivery.
The good news, said Patti, is if Lisa's hospital resubmits her claim with an "explanation of benefits" Tufts will pay the "well newborn nursery charges." However, Tufts won't pay for the delivery, Patti said, because Lisa isn't a Tufts Plan member.
Lisa says she's pretty sure the entire $4,000 bill is for the newborn and is cautiously optimistic about some insurance company eventually paying the bill. "But," she says, "we'll see if it actually gets paid before I have another baby."
This program aired on August 22, 2011. The audio for this program is not available.