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Oct 2014

Ensuring Reimbursement for a Newborn’s Hospital Costs

Welcoming a newborn to this world is a joyful moment for new parents as well as for the health care team that takes part in this miracle. Wondering whether or not the costs of the birth and post-partum hospital stay will be reimbursed by your health plan is usually the furthest thing from anyone’s mind since many healthcare providers assume that a newborn is automatically covered under the mother’s healthcare policy for the first 31 days after birth. Unfortunately, this is not always true.

Although both Federal and state laws offer protections for newborns and parents, it is not always clear as to when these protections are enforceable. So it is important for hospitals and other healthcare providers to know the requirements and limitations on the health coverage afforded newborns so patients  are not left with large unpaid claims after the baby goes home. Federal and state statutes are similar but not identical.

Let’s look at the Federal law first. If the mother’s plan provides maternity benefits, under the Federal Newborns’ and Mothers’ Health Protection Act, the mother and baby are entitled to the following:

  • A minimum hospital stay of 48 hours following a vaginal delivery and 96 hours following a cesarean delivery
  • No preauthorization from the plan is required for the minimum hospital stay
  • As long as the newborn is enrolled in the mother’s plan within 30 days of birth, coverage should be effective as of the baby’s birth date.
  • Self-insured coverage is also subject to the Newborn’s Act. Therefore, hospitals need to make sure that the baby has been added to the mother’s policy to ensure the services for extended hospital stays for a newborn will be covered.

Local laws vary by state. In California, for example, California Insurance Code section 10119 grants mandatory health coverage for a newborn child of an insured “from and after the moment of birth.” However, this unconditional coverage is limited to a period of 31 days after birth. This is so even if the child is sick from the moment of birth. Therefore, any hospital stay for a newborn that extends beyond the 31 day statutory period of mandatory coverage is covered only where the mother applies for coverage within the 31-day period. Hospitals need to make sure that the insured mother has in fact applied for the health coverage for the newborn where it is anticipated that the newborn will have an extended stay.

By making sure that newborns are timely enrolled after birth, hospitals can help ensure that the costs of necessary medical services for the newborn will be covered..

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