r/Insurance • u/Wonderful-Value7547 • Aug 19 '26
Health Insurance Newborn health insurance HELP
Ok here’s a doozy. I gave birth 6/11/26. I spent two additional weeks in the hospital post hemorrhage and neurological concerns thanks to botched anesthesia. By the time I was home recovered and out of the newborn bubble I somehow missed the 30 day enrollment window to get him on my works insurance (BCBS). I missed it by 5 days. I submitted two disputes and both were denied. But took weeks to get a response.
Fast forward to today, I applied for marketplace coverage through the state. Come to find I’m now 6 days outside of the enrollment period for a special event. They are submitting a dispute for me.
I don’t know what the chances are that I will be denied. But I’m curious what people do in these cases? He’s a newborn and has to have coverage. My husband and I make too much money for any assistance programs.
I’m so lost.
2
u/daydreamingofsleep Aug 21 '26
Some people choose to be uninsured due to outrageous costs, at one point our premium cost was $1,600/month.
Going forwards, the county health department has routine child vaccinations for the uninsured. Then cash pay for pediatrician visits (without vaccines there, those push up the cost.)
But the hospital bills are a big problem. People choosing to be uninsured are praying not to have those. File for financial assistance with the hospital when you get the bills. Going forwards check to see if there is a public hospital near you.
1
u/Both-Suspect Aug 21 '26
This is helpful advice to get OP to the end of the year when open enrollment begins for 2026.
1
u/Wonderful-Value7547 Aug 21 '26
Yeah the hospital bills are what worry me because when you’re a newborn or young infant you can’t exactly push off an emergency.
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u/daydreamingofsleep Aug 21 '26
See if the local children’s hospital has a free nurse line to call, ours does and will advise whether to go to ER/urgent care/ped when they open.
The vaccines are $$$ each, outside of the health dept one visit can easily approach ER cost
2
u/Brondoma Aug 19 '26
I work on appeals for healthcare.gov. File an appeal. Explain you were in the hospital. They will waive the timeliness issue.
3
u/OneLessDay517 Aug 20 '26
She was NOT in the hospital the entire enrollment period, nor was her husband.
1
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u/Comprehensive_Ant984 Aug 20 '26
Who cares if she wasn't in the hospital for the entire time? She was critically ill for 2 weeks, recovering from that obviously takes time and makes it completely understandable that she missed the window. Same for her husband, who was dealing with the birth of a new baby, almost losing his wife, and no doubt busy with caring for them both after she came home.
1
0
u/Brondoma Aug 20 '26
Doesn’t matter. She had health issues during that time. It would considered extenuating circumstances.
2
u/OneLessDay517 Aug 20 '26
It apparently does matter, as she appealed twice and the answer was still no.
1
u/QweenKush420 Aug 20 '26
Does your husband work? Do they offer insurance? Have you tried to go through them?
1
u/ste1071d Aug 20 '26
There’s really nothing you can do here short of changing jobs to get different insurance. I can’t believe you just waited for a decision instead of enrolling your baby in the marketplace - you could have dropped the ACA coverage if your appeal was approved.
You should also start preparing for the baby’s bills to be clawed back for anything originally paid out.
Adding - who provides coverage for the other children?
1
u/Wonderful-Value7547 Aug 20 '26
My company’s policy covers my other children.
1
u/ste1071d Aug 20 '26
That was your best hope for an appeal then I’m afraid, as you already have a parent + children plan.
They will absolutely claw back any of baby’s bills.
1
u/Most_Ambassador2951 Aug 20 '26
If you aren't able to get traditional coverage check into concierge medicine. You pay a flat rate(monthly or yearly) and it covers all visits, as many as are needed, and most include vaccinations.
1
u/Wonderful-Value7547 Aug 21 '26
Update: I ended up submitting an appeal through my state and the accepted for market place coverage starting 9/1
0
u/dehydratedsilica Aug 19 '26
Nothing more than was suggested on the other post, unfortunately: https://www.reddit.com/r/HealthInsurance/comments/1vssrdt/need_help_asap_need_coverage_for_my_newborn/
-2
u/Maestradelmundo1964 Aug 19 '26
You can try Medi-cal thru the county that you live in. You mite have to get in line early in the morning. You’ll spend hours waiting to speak with someone. Bring paperwork showing denials.
1
u/Wonderful-Value7547 Aug 19 '26
I’ve spoken to coverME my states equivalent. I missed their deadline just barely as well. Submitted a dispute and waiting to hear back. They already told me I won’t qualify for Maine care or Medicaid as well.
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u/5MinuteDad Aug 19 '26
He was likely added to the plan automatically at least for the first 30 days.
Give BCBS a call and check in with them. If not another good place is your HR team if they are supportive they may be able to work with the broker and get him covered.
10
u/PolkaD0tMom Aug 19 '26
There's no automatically enrolling dependents temporarily, that's not a thing. You're probably confusing it with the exceedingly rare case of a plan offering coverage for a newborn under a parents' plan.
BCBS has no say in enrollments. OP already tried HR, which is the correct route but was denied twice per OP's post.
Unfortunately, there's no getting this baby coverage before open enrollment unless one of them gets another job that offers coverage, and no plan will go retroactive to baby's DOB at this point.
5
u/Initial_Freedom7981 Aug 19 '26
This is incorrect info. The 30 days from birth enrollment if the insured adds the newborn to the plan within the insurance company’s timeline.
-15
u/Glass_Passenger_7422 Aug 19 '26
I don’t understand why BCBS can’t make any exceptions here. There were extenuating circumstances and clearly U have proof on his date of birth. Can’t u get to someone higher up at the company, not your employer? There has to be a supervisor Or someone u can get To rather than their annoying dispute department. If I were u I would Call and harass the crap Out of them until I got to someone with a brain !
6
u/KadrinaOfficial Aug 19 '26
Unfortunately, enjoying parenthood isn't "extenuating circumstances." And open enrollment is usually set not to make employees' lives living hells but usually because of group deals with insurance companies. That is there is a period unless you give birth or change companies (actually extenuating circumstances).
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u/Glass_Passenger_7422 Aug 19 '26
Being In the hospital for an additional two weeks after giving birth due to hemorrhaging is extenuating circumstances
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u/Wonderful-Value7547 Aug 19 '26
I was hemorrhaging lol I wouldn’t call that enjoying parenthood.
Although I admit it was wrong of me after those 14 days.
6
u/Administrative-Low21 Aug 19 '26
Your husband wasn't hemorrhaging...
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u/Wonderful-Value7547 Aug 19 '26
No he was only caring for 3 children (1 newborn) while simultaneously working with no leave lol
2
u/OneLessDay517 Aug 20 '26
Insurance for the baby should have been a priority, particularly if you've done this TWICE before.
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u/Wonderful-Value7547 Aug 20 '26 edited Aug 20 '26
Thanks for reminding me. God forbid a mom tries and prioritize their own health!
2
u/Dapper-Survey1964 Aug 20 '26
I'm sorry people here are being unproductive and AH-ish. The window already closed, telling you not to miss the window is dumb. I'm so glad you're on the mend! Sounds like you might just have to tough it out and pay out of pocket for the new baby until the new year. Silver lining is they were born late in the cycle!
-1
u/Immediate-Ad-9520 Aug 20 '26
My first time in this sub and WOWZA. Sorry people are so crappy, OP. You and your husband had a rough go of it and it’s absolute BS that insurance can get away with this stuff. New parents should be focusing on the child not this admin crap. But that doesn’t help you. Honestly in your position, I’d look for another job and be wildly honest in the exit interview.
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u/KadrinaOfficial Aug 19 '26
The first 30 days will be under your insurance, so the hospital stay will be accounted for. The past week will not.
Unless he has been to the doctor this week, I would just focus on getting him on any insurance until either you or your husband's company have open enrollment.
3
u/Resse811 Aug 20 '26
That is not true. The first 30 days are only covered under moms insurance - if the baby is added to their insurance within the window.
10
u/retatrutider Aug 19 '26
This happened to me, and to make matters worse, my wife’s company (who was providing coverage through BCBS) is self insured so not subject to the insurance commissioner and certain regulations. Since the baby was in the ICU for the first month, we had a six figure bill that supposedly wasn’t covered.
Ultimately, after fighting for six months we found out that the baby’s first 30 days in the initial hospital stay are covered under the mom’s insurance, regardless of whether the baby was added. The insurance company didn’t volunteer this… we had to find it out on our own and get the hospital to bill it that way specifically.
Since we missed the window to add him to her insurance, we had to get him a new plan under the ACA marketplace. So we did that and paid a couple hundred a month until the following year, which was much better than the $100k+ bill we originally received.
So get him in a paid plan through the ACA asap before anything major goes wrong, and get initial hospital stay covered through the mom’s insurance.