Health insurance is incredibly fucked up in the United States, that much is certain. But a recent NPR report shows a higher dimension of fucked-upness by explaining something called the “birthday rule” which affects children on their parents’ insurance. Apparently, if a child has two parents insured under two different policies, the parents do not get to choose which policy covers the child. “A child with double health insurance eligibility must take as primary coverage the plan of the parent whose birthday comes first in the calendar year; the other parent’s insurance is considered secondary,” NPR explains. This little known rule came as an unpleasant surprise to a pair of first-time parents whose infant suffered from complications at birth that resulted in a short but expensive stay in the NICU.
Mikkel and Kayla Kjelshus reportedly decided that their child would be insured under Kayla’s policy for financial reasons that they should not have to explain because it is their child and they should get to decide how to insure their own child. Initially, Kayla’s insurer Blue Cross Blue Shield started making payments to the hospital for the NICU stay when without warning the payments were canceled by the insurer. The hospital where Kayla delivered her daughter started sending bills to the Kjelshus home totaling over $200,000.
Because of the birthday rule, the child’s insurance was supposed to default to Mikkel’s policy “with a $12,000 deductible, high coinsurance obligation and a network focused in a different state.” It turns out that Kayla’s insurer launched an investigation into whether Mikkel was insured or not and when they discovered that he was, a fact that was not a secret, they refused to cover NICU expenses.
Instead, Mikkel’s inferior policy was hit with the bills and after the hospital and the insurance company came to an agreement on the final cost, and the family was still hit with a bill for $19,000 just for trying to make sure their child did not die immediately after birth. Eventually, the Kjelshus family was able to resolve the issue with their insurers and the hospital after two years of phone calls, emails, and intervention by Kayla’s employer.
But the birthday rule that caused these already stressed out and frantic parents dealing with their baby’s health crisis even more unnecessary anxiety and suffering still exists, waiting in paperwork to ruin more lives. The rule was instated by the National Association of Insurance Commissioners and is active in most states and if you have never heard of it before, perhaps now is the best time to call your insurer and ask them about coordination of benefits.