I-Team: Separate insurance plans causing expensive headaches for new parents
DALLAS (CBSDFW.COM) – With two separate health insurance plans, Chris and Lauren Lewis were not worried about the hospital bill when their son, Langston, was born.
"I had insurance. My wife had insurance. We were double covered," Chris Lewis said.
However, the Lewises soon found out having two separate insurance plans, at times, can feel more like having none.
Fourteen months after Langston was born, the Lewises received an unexpected bill for $4,160 from Baylor Scott and White hospital for the birth of their son.
After a year of negotiating with their two insurance companies, the hospital told the Lewises both of their insurance plans had declined to pay.
"We were like, 'Are we going to have to pay out-of-pocket for this cost?' It doesn't make any sense," Chris Lewis said.
When parents have two separate health insurance plans, the question on whose plan is going to cover the newborn child is often unclear.
"When this happens, it creates an opportunity for each insurance company to point the finger at the other," said Sabrina Corlette, J.D., the co-founder and director Center on Health Insurance Reforms at Georgetown University. "And more often than not the patient or the consumer falls through the cracks and gets stuck with the bill."
Lauren Lewis had health insurance with United Healthcare. The insurance company told CBS 11 News, when both parents have separate insurance, it follows the "birthday rule." Under the rule, the parent whose birthday falls first in the calendar year is the one whose insurance is responsible to cover the birth of the child.
A United Healthcare spokesperson told CBS 11 News, "Under Texas health insurance rules, Mr. Lewis' insurance should cover the hospital bill for their baby because his birthday falls before Mrs. Lewis' birthday in the calendar year. We are working with his insurer to help them resolve this hospital bill."
The "birthday rule" model was adopted by National Association of Insurance Commissioners as a way to settle coordination of benefit disputes between insurers.
Under the Texas Insurance Code, state regulated health plans, held by 15% of Texans, are required to follow the "birthday rule."
However, most employer sponsored health plans, held by 38% of Texans, are regulated by the U.S. Department of Labor and there is no federal rule that governs which insurance coverage applies to a birth when both parents are individually insured.
This was the case with Chris Lewis' insurance plan. He has an employer sponsored plan administered by CareFirst BlueChoice. The Lewises said CareFirst BlueChoice told them since they were both separately insurance, the mother's insurance plan would be responsible to cover cost of the birth.
CareFirst BlueChoice did not respond to questions from CBS 11 News, however, after CBS 11 News contacted both of Lewises' insurance companies, the Dallas couple said they received a call from Baylor Scott and White. A hospital representative told the family it has escalated its case and is working with CareFirst BlueChoice to cover the bill.
A hospital spokesperson told CBS 11 News, "We understand and empathize with the complexities patients face at times, and we are working directly with (the Lewises) to help and find resolution."
Corlette said the reason these types of coordination of benefit disputes occur is because insurance plans don't all follow the same rules or are even regulated by the same government agency. The Texas Department of Insurance regulates fully funded state insurance plans, the U.S. Department of Labor oversees most self-funded employer sponsored plans, and the U.S. Department of Health and Human Services regulates government health plans, such as Medicaid, Medicare, and military plans.
"In the U.S. we have this very fractured system of health insurance," Corlette explained. "The burden is almost always on the individual, the consumer, to navigate the system and big trouble for you if you get it wrong."
In July 2021, federal lawmakers introduced the Empowering Parents' Healthcare Choice Act. The bill would give parents, with dual insurance plans, the right to choose which health plan would be the primary insurer. The bill is currently in the House Subcommittee on Health.
"Welcoming a child into your family should be a joyful event, free from undue stress and financial burden at the hands of insurance companies," said U.S. Rep. Sharice Davids (D- Kansas), who authored the bill. "This is a simple fix that gives parents the power over their baby's healthcare coverage, so they can make an informed choice about their family's future."
But even if the bill passed, the law would not apply to all health plans. As this is a federal bill, it would only apply to plans regulated by the federal government.
The Texas Department of Insurance encourages people to contact its helpline (1-800-252-3439) if they are having issues with coordinating benefits with their health insurance plans.
