Health Insurance Lesson Learned Almost the Hard Way

We had our second son back in late February of this year. I suppose we have been in baby mode for the past month and a half because apparently we are not thinking practically. Earlier this week my wife went to the Doctor’s office for the babies check-up, and she was informed that our newborn was not on the insurance policy through my wife’s employer. So I began asking questions about why our son had not been added yet to the policy because her work clearly knew we had a baby?

The big scare came from my wife’s best friend, who told her we only have 30 days from the date of birth to add our new son to the policy. Well we are several weeks beyond the 30-day enrollment period and started to panic. So the phone calls rapidly started to figure out our game plan.

Message left with the local admin. Message left with the corporate office. Waiting. Panicing. What if we are not covered? What could the pitfalls be? How much are we going to be responsible should our new son not be covered? This could cost us a LOT of money. If we can no longer add our son to the policy, when is open enrollment? What do we do in the meantime? Obviously lots of scenarios played out in our heads as we waited for somebody to call us back.

I talked with my wife’s medical insurance provider and they informed me that any changes have to go through my wife’s employer, and it is up to them whether they will accept an additional dependant outside of the enrollment period. So we continued to wait for someone from my wife’s employer to call us back.

Finally about an hour later my wife received the call she had been waiting for regarding our enrollment. Luckily, they said this type of thing happens all the time, and it was not a problem to add our son to the policy, even though we were beyond the new dependent enrollment 30-day period. They were quickly able to add him to the policy over the phone, except I had to stop by the office to pick-up the formal enrollment paperwork.

So the lesson learned was that you need to add any dependents to your health insurance plan ASAP after birth. The hospital does not do it for you. In addition, just because your employer may know you had a baby, you need to follow through to make sure that the dependent is indeed added to the policy. In our scenario, we got extremely lucky.

The insurance bills have just started to come in, so nothing has formally come in yet as being denied. We just happen to find out for some reason at the doctor’s office, which in itself seems particularly strange because in my experience, doctor’s offices always seem to handle insurance submission and billing after you leave the office. Had we not got so lucky with being able to add our newborn son to the policy, our financial outlook, and possilby years of savings, could easily be wiped out by a simple mistake.

If my wife’s employer and the insurance company did not add our son to the policy, we could be responible for 100% of the costs associated with the labor and delivery under his name (in other words, my wife would still be covered under her policy, so we would only be responsible for any bills racked up in our son’s name). The bills could easily be in the thousands of dollars, even up into the five-figure range. In addition, any future vaccines, doctor’s visits, etc. would all have to be carefully coordinated to minimize costs.

Another option we could have considered if feasible would be to add our son as a dependent through my insurance policy. Currently, I have single coverage through my work. My wife has both kids and her under a family plan through her employer. Therefore, by default, I have secondary coverage through my wife’s policy. I actually come out the best on health insurance coverage because I am the only one with primary and secondary coverage. The arrangement to have my wife with the family policy and me as single coverage is the cheapest solution based on our scenarios. If the kids were on a family policy through my employer, we would have a lot higher out-of-pocket expenses both through automatic deductions as well as co-pays and other associated costs.

Note, both my wife and my insurance policies require the spouse to have primary coverage through their own employer. So as long as I have a job with insurance coverage, I must take primary coverage through my work. Likewise for my wife; I can not add her to my insurance plan as so long as she has primary coverage available at her employer. We got lucky, so do not less this happen to you.