Anyone have issues with this?

We had our twins early at 34 weeks, 6 days and ended up spending 14 days in the NICU. The entire time, we were not concerned about the finanical aspect of the stay because we have insurance and we would only end up being responsible for the $800 deductible and $1500 per child for the max out of pocket. However, I just got my explanation of benefits in the mail and they say we failed to pre-auth the twins stay and therefore have a 50% co-pay. We are now looking at a $35,000 bill instead of $3800. I thought that their stay would be covered under mine (pre-certified) because they were not enrolled in my insurance until 2 weeks after they were born. The insurance was retro to date of birth. Has anyone had this happen to them? Did you have to pre-auth if your kiddos went to the NICU? I've gone over our policy a zillion times and it doesn't spell out that you have to call in this particular event. I'm going to call my insurance tomorrow and see about getting the co-pay removed. Any advice, I'm freaking out here!!!! Great time to get an insurance statement on the weekend of a holiday!!!!

 

Insurances are pains. We did call them to let them know, but I never would have known that if my insurance companies complimentary call nurser didn't tell me. I am sure they will take care of it, you just may have to fight a little. I had to call several times to resubmit claims for my boys, but they always took care of it. Hope it all works out.

 

You'll have to call them first and find out what the issue is, could be something as simple as human error on their side. They might be able to retroactively authorize it. Worst case, you can appeal the decision, your plan should have detailed instructions on the appeals process.

 

Wow, that is insane. I never had to get an auth for any of my kids, they were just added retroactively. I would definitely call and file an appeal/resubmit the claims.

 

QUOTE(mommyrn @ May 25 2009, 11:30 AM) [snapback]1327188[/snapback]
Did you have to pre-auth if your kiddos went to the NICU?


No, we did not. How in the world would you be able to do that if you are having an emergency delivery and the babies go right to the NICU? Ask them to wait to deliver, so you can call your insurance company? :umm: Anyway, I would think there is an error from someone somewhere. That makes no sense to me at all. I spent days on the phone over stuff from the NICU, but in the end it was always covered and we just had co-pays. :gah: :hug:

QUOTE(becky5 @ May 25 2009, 11:39 AM) [snapback]1327199[/snapback]
I never had to get an auth for any of my kids, they were just added retroactively.


Same here. I was told both times that I had babies that we had 30 days after their births to add them to the insurance policy and that they would be covered without issue.

GL!

 

Our insurance gave us 90 days to enroll the kids and covered them until that point. This was because they needed a social security number to enroll. I have had to fight many battles with the insurance company since the boys were born and have won them all. You just have to be persistent and sometimes a little mean. Just the thing a new twin mom wants to deal with right? I hope it works out well for you!

 

i would definitely call them. if your insurance is through an employer i would find out if there's an employee advocacy line you can call as well. we had a lot of medical bills denied because there's an automatic flag in most insurance company's systems that kicks out "duplicate" filings. you may find out that you've been caught in the automatic flag and you need to have them manually set your account to expect double claims for twins.

 

QUOTE(DATJMom @ May 25 2009, 02:05 PM) [snapback]1327342[/snapback]
I was told both times that I had babies that we had 30 days after their births to add them to the insurance policy and that they would be covered without issue.


:good: This is what I was told as well. I'm so sorry you have to deal with this. :gah: I hope it gets solved quickly. :hug:

 

This happened to us, don't worry...I resubmitted the claim and explained in a letter that obviously I wasn't in control of when these children were born and being in the NICU is considered an emergency which has to be covered by the insurance...the hospital is usually responsible for getting preauthorization for you anyway...they should have taken your info at some point and contacted the insurance company. Don't worry I'm sure it will get sorted out sometimes is just takes some calls and letters (which can be a pain) but it is definitely worth fighting!!!