r/HealthInsurance • u/Thinking_Man_1990 • Jul 09 '25
Claims/Providers Insurance broke my wife. How is the system so bad?
My wife's the most calm and collected person I know. But Cigna and United Healthcare customer service finally broke her.
Wife gave birth to our first child. She had United Healthcare, I am on Cigna. Added baby to my Cigna shortly after birth. Nearly 4 months later and close to 20 calls later, baby's delivery claim is sitting denied by Cigna. Cigna wants an EOB from United Healthcare (as the mother's default), United Healthcare said they never received Baby's charges from the hospital (just the mother's) hospital says they can't do anything and we should speak to insurance. It's surreal how utterly helpless the system can make you feel..
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u/shaylak Jul 09 '25 edited Jul 09 '25
It sounds like Cigna thinks there is coverage under UHC. Have they clearly been told that baby was never added to the mother’s insurance? If so, do you obtain your insurance through your employer? If you are having this much difficulty, I would reach out to them and see if they can escalate to their Cigna contacts to get a resolution. Sorry you’re going through this.
ETA: What state are you in?
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u/throwaway978812 Jul 09 '25
This. It’s frustrating situation due to the hoop jumping needed to get through the administrative process, but this is VERY solve-able! Don’t stress and be persistent in dealing with all parties.
1
Jul 30 '25
YOU'RE LIFE WILL BE BETTER WITHOUT AMBETTER! AMBETTER IS A JOKE AND COMPLETELY UNRELIABLE! DO NOT CHOOSE AMBETTER! They will deny just about anything from co-pays on medical bills and the ' Ambetter Rewards Program' gives you no rewards, only frustration and hours on the phone trying to figure out why the card they sent cannot be used where they say it can be. Different representatives have different rules. DO NOT USE AMBETTER AT ALL, IT'S A VERY UNRELIABLE 'company'! Your life will be better without Ambetter!
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u/OrganicInfinite Jul 09 '25
Make sure you are aware of the Birthday Rule and whether it applies in your situation. This can cause claims to be denied and issues with coverage in the first year in some cases.
https://www.ehealthinsurance.com/resources/individual-and-family/birthday-rule
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u/HealthcareHamlet Jul 09 '25
This should be higher. Most plans have an auto enroll for the newborn for the first days of life. Doesn't matter which HR was alerted, they follow the plan. Whomever's birthday falls first in a calendar year is primary for the newborn. That is who you push on and escalate until a qualified person can speak on it.
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u/endiqua Jul 09 '25
Yup, all of this. It’s hard to get this straightened out sometimes. Find out if there was any automatic newborn coverage via benefits dept/employer. If there isn’t any, provider can rebill UHC to get a “no coverage” denial with the charges deemed “patient responsibility” to send to Cigna. Alternatively or also, a letter from the benefits dept of the UHC employer saying there was no coverage may help. Calling Cigna may also be helpful, as a lot of insurance companies won’t take a provider’s word about other coverage. Good luck!
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u/onions-make-me-cry Jul 09 '25
But that auto enroll only "holds" if the baby is added to the mother's plan later, right? That's been my understanding. Since he was never added, the claim should reprocess against Cigna as sole coverage once the baby is born.
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Jul 30 '25
YOU'RE LIFE WILL BE BETTER WITHOUT AMBETTER! AMBETTER IS A JOKE AND COMPLETELY UNRELIABLE! DO NOT CHOOSE AMBETTER! They will deny just about anything from co-pays on medical bills and the ' Ambetter Rewards Program' gives you no rewards, only frustration and hours on the phone trying to figure out why the card they sent cannot be used where they say it can be. Different representatives have different rules. DO NOT USE AMBETTER AT ALL, IT'S A VERY UNRELIABLE 'company'! Your life will be better without Ambetter!
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u/Fantastic_Fig_2025 Jul 09 '25
If an insurer follows the birthday rule, no. Their policy would state that whichever parent is born first is responsible.
I called my insurance in advance to confirm that they don't follow this rule and they confirmed they do not. However, it isn't a very well known rule in my opinion. I only found out about it from hearing a horror story.
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u/onions-make-me-cry Jul 09 '25
The birthday rule only applies if the baby is enrolled in both parents' policies. I've never heard insurance can enforce it when the baby is enrolled in only one. I am a Benefits Broker.
Someone chime in here if I am wrong. Thank you!
3
u/xnef1025 Jul 09 '25
Auto-enroll means the plan will automatically enroll the child for a temporary period of time without the subscriber having to contact the employer to add the baby. Many UHC policies have this. If the provision does exist on the plan, UHC will add the baby upon receipt of the claim and process per benefits. If it doesn't, they just deny the claim for patient not enrolled.
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u/Fantastic_Fig_2025 Jul 09 '25
Baby bumps was full of people who ran into this issue. I am basing it off of anecdotal evidence. I think the issue is they always have the mom's insurance so if you aren't using hers, they may autobill it.
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u/onions-make-me-cry Jul 09 '25
But all that happens is that it needs to be corrected and then all the claims reprocessed.
The baby being auto enrolled in the mom's coverage is so that the baby never has a point where he's not covered - it's the Maternal and Newborn Babies Act. And some fathers have policies that don't allow you to enroll a baby effective as of his birthday, the effective date is the 1st of the following month after birth. So the baby would need to be covered through any gap, like the one created by that example.
It doesn't mean that the coverage will stay that way once the father actually enrolls the baby in the father's policy and the mother doesn't enroll him in the mother's policy. It means you need to report to the primary that the baby was never enrolled in any other coverage and the claims need to be reprocessed back to the appropriate insurance as the sole coverage for baby.
I have helped a lot of people deal with this issue in my work.
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u/Fantastic_Fig_2025 Jul 09 '25
Again I'm only reporting what I saw people have happen in a pregnancy-based subreddit.
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u/Extension_Low_1571 Jul 09 '25
Yep, for the first thirty days of life, baby is covered under Mom’s policy.
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u/Remote_Focus_4521 Jul 09 '25
This is not true. Stop spreading false information. You have to add the baby to insurance within the specified time period per the plan, otherwise no, they aren’t covered.
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u/Extension_Low_1571 Jul 09 '25
Here in CA, baby is covered under mom’s policy (whether she’s the insured, or covered as a dependent) for the first 30 days of life. After that is when baby needs dependent coverage. 20+ years in the industry.
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u/Vegetable-Scratch423 Jul 22 '25
Was gonna say that it’s the same in TN as well. I’m due to have my second next week per induction and had my first back in 2023, and they confirmed for me recently that this is still policy.
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u/xnef1025 Jul 09 '25
Still depends on COB rules who pays first. Most plans follow birthday rule for children when the parents are together, so whichever parent's birthday is earlier in the year will be primary. If OPs birthday is earlier in the year than the wife's, they should call Cigna and inform them of that since it would make further delays of payment pointless.
If wife's birthday comes first, they need to double check with UHC to make sure the plan even does auto-enroll for newborns. If it does, they'll need to get in contact with the provider's again to make them submit to UHC as primary.
If Cigna is supposed to be primary, but being jerks about it, the smart play would be to just make the provider's send to UHC anyway to generate the denial EOBs that will force Cigna's hand.
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u/Texylvania29 Jul 10 '25
This is not always true. It is plan dependent. I was told this over and over and then shocked when my son was born he had a whole new deductible and our plan OOP max increased.
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Jul 30 '25
YOU'RE LIFE WILL BE BETTER WITHOUT AMBETTER! AMBETTER IS A JOKE AND COMPLETELY UNRELIABLE! DO NOT CHOOSE AMBETTER! They will deny just about anything from co-pays on medical bills and the ' Ambetter Rewards Program' gives you no rewards, only frustration and hours on the phone trying to figure out why the card they sent cannot be used where they say it can be. Different representatives have different rules. DO NOT USE AMBETTER AT ALL, IT'S A VERY UNRELIABLE 'company'! Your life will be better without Ambetter!
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u/RevolutionaryDust449 Jul 09 '25
We were getting our insurance for our newborn denied until we provided proof of baby being only on 1 insurer. Apparently it’s common for parents to have separate insurance and put baby on both, so insurance companies won’t move forward until they confirm the other insurers coverage (or lack of additional coverage).
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u/melonheadorion1 Jul 09 '25 edited Jul 09 '25
Not sure why everyone makes this harder than it needs to be. Its very simple. If the child is only on one insurance, and cigna is denying because they need a different carriers eob, it's literally as simple as contacting cigna to have them update the cob/ coordination of benefits to show they are primary. This is literally all that needs to be done. The claim will auto adjudicate after that.
This is just charges for the child. So everything up to, and including delivery for your wife, would have to go through her insurance first. The child's claims won't start until it is actually born
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u/SpecialEdge1610 Jul 09 '25
Because there are no classes on how health insurance works, that's why it's so hard.
It is not intuitive, and the people you call don't offer you any help.
OP, I was told by Cigna that we have 18 months to sort these claims out, its annoying but you have time. Just keep bugging them. I know it's hard because you have a newborn, but just annoy them.
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u/thornyRabbt Jul 09 '25
It is not intuitive, and the people you call don't offer you any help.
Totally agree with this. And the only billing errors I've had, in 20 years of transactions, have been with insurance companies.
Whether that's a "convenient mistake" that always happens to benefit the company I don't know, but if I were to play naive, it could also be because medical billing is the most arcane, confusing, and constantly shifting battlefield in existence. A hospital can't even give you an estimate of how much something is going to cost.
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u/melonheadorion1 Jul 09 '25
That wasn't my point with how easy it is. Some responders, you included, give advice that isn't useful. Hate to say it, but simply "bugging them" is not the fix. Most others add in writing letters, doing this, or doing that, while people that know how to navigate this, give proper advice, and do offer help.many of us work in insurance, and have to combat the conspiracy answers that just demonize, or give improper advice
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u/SpecialEdge1610 Jul 09 '25
Got it, they work for the company denying OPs claim, please tell insurance companies to develope a handbook to help us normies out.
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u/melonheadorion1 Jul 09 '25
Fact is, most people don't try to learn. They just want it fixed. They don't care how or why. I've never, in the last 16 years of doing insurancestuff, have anyone ask me for knowledge on how things work
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u/SpecialEdge1610 Jul 09 '25
Please, I want a roadmap for dealing with insurance, I receive an infusion medication that they tried to bill me 80,000+ dollars for.
Because I got a new job (They started insurance benefits with no waiting period) and was double insured, had not received my card or login for my Cigna but paid COBRA for the old plan that had previously authorized the treatment.
They (BCBS) then denied my claim after paying because they found out about my other insurance, Cigna then denied because they didn't prior authorize.
Where the fuck in the fine print did it tell me that once you get new insurance COBRA benefits are treated as secondary insurance. I paid over $700 to continue it for the month. Not one thing that I received stated that the second new coverage starts the money I spent out of my own pocket post tax was just thrown away.
All the hoops we are supposed to jump through are invisible, there is no education apart from trial and error. If you get an unexpected bill in the mail for as much or more than your yearly salary.
Seriously start a YouTube series on how to navigate insurance I would love to learn how to deal with varying scenarios to help friends and family if they get a scare.
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u/melonheadorion1 Jul 09 '25 edited Jul 09 '25
"Where the fuck in the fine print did it tell me that once you get new insurance COBRA benefits are treated as secondary insurance. I paid over $700 to continue it for the month. Not one thing that I received stated that the second new coverage starts the money I spent out of my own pocket post tax was just thrown away." did you ask? did you bother looking it up? you can google search and find this answer. problem is, for you, just as it is for anyone else, dont look into things before they happen. you reacted to it, after it happened. its not to slight you in any way, but its literally what you just said, and is common with people, and how the human brain works most times. people just dont think ahead. its like they know there is something they need to know, but if they ignore it, its fine. i hear the same thing on this multiple times a week. "how am i supposed to know?" ASK. no one can know what level of knowledge people have, or even if they are accepting of info. you will see many responses where people prefer to acknowledge a conspiracy answer more than facts, because "insurance bad". giving a roadmap just isnt possible, because i will be here for days trying to explain things that lead into other things, that lead into others.
the other side to this is, if you ask a question, youre going to get an answer, but people dont know what answer you want to something, that you arent asking, so if you ask a question, you will get the answer to that question. if you need more clarification, or more about the same topic on something, you need to drill down additional questions to get more answers. this is just the human nature side of things when it comes to getting and giving answers.
starting a youtube series on it, would be a great idea. problem really is, after a days worth of work, i dont want to continue doing it after im done too. just answering responses on reddit makes it feel like im still at work.
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u/SpecialEdge1610 Jul 09 '25
No, that's the wrong answer.
When you supply a service, this should be spelled out to the consumer, digging for the answer and spending hours researching is not right.
Health insurance companies should be up front with exactly what's going on.
We are just regular people with BS diseases, some of us working much longer hours. A lot of people do not have time to reach out to the insurance companies. We don't know what exactly to search on Google. We don't know where to go. We don't know the insurance company lingo we don't really understand the doctor lingo.
Unfortunately there are so many other factors that can complicate this issue, we are professionals in our own individual professions, we don't understand what you guys are telling us on the phone. We are scared we saw something frightening in the mail, something that may bankrupt us.
Quite frankly "giving a roadmap just isnt possible, because i will be here for days trying to explain things that lead into other things, that lead into others" is the issue. The system should not be that complicated.
I definitely read your messages as you think we are beneath you, and that people are just dumb and it's their fault. "you need to drill down additional questions to get more answers" the problem is people do not know what they need to ask to get where they need to go.
In the United States, healthcare should not be as hard as it is. Insurance companies have muddied the waters and it's too hard to see through anymore.
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u/melonheadorion1 Jul 09 '25 edited Jul 09 '25
in your opinion, its the wrong answer. its the epitome of being an adult and gaining knowledge. if we were talking on the phone, to discuss and teach you everything, it would be a conversation many hours long.
the people that answre the phone are regular people too. you may not know what to google search, but the person you speak to doesnt know what info you want to know, unless you ask. saying anything otherwise is just an excuse.
"Quite frankly "giving a roadmap just isnt possible, because i will be here for days trying to explain things that lead into other things, that lead into others" is the issue. The system should not be that complicated." you mistake this answer for it being complicated. thats not what i mean, nor what i said. if you want a roadmap, it means i have to explain what a copay is, all the way up to the most intricate scenario. this roadmap that you desperately want would take me days to explain, because i would have to go over every minute detail. thats why its not possible.
"I definitely read your messages as you think we are beneath you, and that people are just dumb and it's their fault. "you need to drill down additional questions to get more answers" the problem is people do not know what they need to ask to get where they need to go." i dont think youre beneath me. if thats how you take it, whatever. however, ignorance is not bliss. i was taught, growing up, if you dont know the answer, you should find out. getting arrested for breaking a law, guess what, the judge is not going to take "i didnt know" as an answer. sometimes people need to take the initiative for their own life, take responsibility for what they dont know, and figure it out. thats just life, and not specific even to the conversation. being lazy, or lacking in knowledge, isnt an excuse. the regular people that you talk to on the phone are not insurance experts. most of them have probably worked there for a year or less, and the fact will still remain; they dont know what you want to know until you ask. not a single person ive ever dealt with, is a mind reader, nor can they predict what yyou might want to know, or what your specific scenario is. for example, when you chose cobra. doesnt sound like you inquired anywhere as to who would cover you in that instance, and maybe because its that you didnt know, but not one single person reached out to you to explain anything, because they dont know anything about your situation either. your thought is that people should be able to tell you "hey, youre effin up here by doing this", when you took steps on your own behalf to do what you did. it would require the ability to see the future, or be in your head to be able to predict questions that people want or need to know.
additionally, responses like that, and unwillingness to listen is what makes people, who are knowledgeable, not want to answer. having to combat excuses.
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u/ffffffff420 Jul 30 '25
people like you are the problem with the insurance industry. completely lacking in compassion, empathy, and awareness that this country’s healthcare system is simultaneously the most expensive and worst in the developed world. shame on you.
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u/xnef1025 Jul 09 '25
19 years working uhc customer care, and you are missing an important piece. Many plans auto-enroll newborns for the first 30 days. That's why Cigna is doing this. If the newborn can be auto-enrolled on the UHC plan, the Birthday Rule would apply for COB. Cigna won't update COB and pay the claims until there is enough info to verify either the enrollment situation with UHC or that Cigna would be primary either way.
So the first question is, who's birthday comes first in the year? Mom or dad? If dad, call Cigna, inform them of mom's DOB and that it doesn't matter if the kid was on the UHC plan, Cigna is still first and needs to process the claims for benefits.
If dad's b-day is first, call UHC to find out if the plan auto-enrolls newborns. If yes, they will be primary. Regardless of the answer in this case, OP will need to call the providers and have them submit to UHC to get the necessary EOBs to make Cigna happy.
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u/AEHAVE Jul 09 '25
Cigna needs the complete EOB so they know what to pay. Either the hospital is holding out info of on UHC, or UHC is holding out on Cigna. I would recommend a DOI complaint against UHC for starters.
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u/melonheadorion1 Jul 09 '25 edited Jul 09 '25
this is exactly what im speaking of. a DOI complaint is pointless. you officially would be making it harder than it needs to be. UHC already said that they never got the claim. they are officially out of the loop of any problem that there is here. until they get a claim, they have no liability in any claim processing. may as well report aetna to the DOI.
Cigna only needs an EOB if the child is on both plans, but Cigna cant get the EOB until the secondary plan processes the charge, and if they dont have a claim, there is no eob.
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u/Extension_Low_1571 Jul 10 '25
And DOI doesn’t apply with an HMO Plan, in CA that’s DMHC jurisdiction
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u/Yoder_TheSilentOne Jul 09 '25
mine was son was born premature, they took my wifes insurance and assumed thats who we were putting him on. I added him to my insurance within the 30 days and notified the hospital billing.
5 months later, they billed my wifes who denied claims as son was not on theirs. we were now oweing about $200k.
told all providers involved wrong insurance was billed. 1 month later, my insurance eob shows them paying $0 as preauth wasnt obtained as they used my wifes to get preauth.
so adjustments knocked it to $156k but no payment from insurance. called my insurance group and was told provider has to send them authorizations to reprocess claim.
1 month goes by showing nothings changed. asked my insurance group who advised they never sent claims to be reprocessed as my employer switched insurance groups without telling me. so old group is locked out of claims process.
contact new group and have to call providers again to resubmit claims to new group and authorizations. providers say no old group handles that not new insurance group. had to say that is what both groups are telling me. they ask is it wifes insurance to send to? no its mine take my wifes insurance off my sons account.
had to have new group call providers to get it settled after 4 hours of getting run around.
mad at my old insurance group who told me for two months they would get claims reprocessed but never did then say oh you have a new group now not our problem.
2 months go by and what do you know i get a bill for $11k saying my insurance paid $0. call provider who said the matter was settled by old insurance group. No! i explain again send authorization and claims to new group and they refused. called new group and they called provider who gave them run around and said its in mediation between new group and provider.
three times since ive been asked by same provider for appointments is it wifes insurance hes under. No dang it! ive said 5 times take that off his account!
this is ridiculous
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u/GzrGldGeo Jul 09 '25
Healthcare companies main goal is to deny coverage. That's where the profit is. I am 66 years old and have to fight nearly every claim. Until the Government decides this needs to be fixed, it will get a lot worse.
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u/SupermarketSad7504 Jul 09 '25
United or her employer can provide verification that baby is not nor has ever been insured by them However its also possible that some plans cover the baby stay under mom as a courtesy. They want to confirm united will not pay. Hospital can resolve this easily by sending united a bill.
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u/butchudidit Jul 09 '25
Everyone is one medical bill away from washing away all your life savings. Insurance indus is fucked. Third party payers are fucked. US healthcare is fucked and only treats on a reactive basis not preventative driven by profit motives
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u/ElleGee5152 Jul 09 '25
If there was no coverage with UHC for the baby back to the time of birth, you need to have Cigna remove the UHC plan from the baby's Coordination of Benefits (COB) information. If they need proof, UHC should be able to provide a letter stating the baby was never added to mom's plan. You don't need to file complaints or write letters or whatever else was suggested by laypeople, this is the fix if UHC was never active for the baby.
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u/belai437 Jul 09 '25
Haha.. this is a famous story in my family as Cigna broke my family member too. Relative had baby in 1996 in the only area hospital Cigna participated with. Week before baby was born, this hospital was bought by another system and changed names. Cigna charged the c-section birth and stay at the non participating rate. They would not accept that hospital changed names week before- did not care. Hospital bombards relative with bills for $5k and trying to get them on payment plan, finally starts threatening collections.
WHEN THIS BABY WAS TWO OMG THIS SHIT WAS STILL GOING ON! Relative calls Cigna and goes over the story. Per usual Cigna says the hospital was non par blah.. blah.. blah.. and my relative lost her entire shit. Screamed obscenities at the top of her lungs for a good 3 minutes until the terrified rep escalated her to some higher up.
Situation was fixed that afternoon and my relative later got a bill for $600, which is what she expected to pay.
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u/gardeningistherapy Jul 09 '25
Every time you talk to the insurance people document it, ask for a reference number and name of who you spoke with. Then if you need to complain to your insurance commissioner you have a record. I agree with others there’s a coordination of benefits issue happening, super frustrating.
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u/Bongsoir Jul 09 '25 edited Jul 09 '25
I would look into this federal law, Newborns' and Mothers' Health Protection Act (NMHPA): https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/nmhpa_factsheet
It sounds like baby was added to your Cigna policy and not mom's UHC policy, but now your Cigna policy is thinking that mom's UHC is responsible for the delivery, even though baby hasn't ever been added to mom's UHC policy. Your insurance is doing that because of this federal law.
Call up your wife's insurance company, UHC, and find out if her UHC policy is required to follow this law (all explained at the link I provided). If so, then your provider must file to UHC because of this law. If not, UHC needs to give you proof that the UHC policy does not have to follow the federal law and you or the provider will have to appeal the denial with the proof.
From the link "This law applies to two different types of coverage:
Group health plans (provided by an employer or union);
Individual health insurance policies (not based on employment)."
I'm saddened that your provider's billing department nor your insurance company representatives were aware of this federal law..but I'm not surprised.
Good luck!
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u/xXazorXx Jul 09 '25
Newborn coverage can be complicated, especially if state laws are involved. If you can answer the below I can look up the rules for you to tell the carriers.
Whose birthday comes first in the year?
What state do you reside in?
Is your plan fully insured or self-insured? If fully insured what is the situs state? (Cigna can tell you this just ask)
Same info as above for your wife’s plan.
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u/Binkams Jul 09 '25
I’m in California, when I delivered my baby, they put him in my plan automatically for 30 days, my insurance is from my employer. I thought my husband’s insurance is better which is Cigna so after 30 days my baby’s insurance is only Cigna which ended up the absolute worst so when it’s finally open enrollment, I added up my baby again on my insurance and that’s when the parents birthday rule applied. Hospital/ clinic needs to be informed that my child has 2 insurance so they can send the bill to the secondary insurance whatever Cigna (primary) didn’t cover… which is everything. The hospital/clinic is the one who’s going to send the bill to the insurance companies. I’m sorry you’re going through this. Insurance fight is very stressful.
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Jul 09 '25
Living in New York I've finally solved several of these situations by informing all parties by certified letters that I am filing a complaint with the State attorney general's office. Almost immediately they called me back and worked it out.
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u/nothing2fearWheniovr Jul 09 '25
I hear you, went through a lot when I had 2 knees done with 2 different insurance companies. Really makes you want to limit how often you go to a doctor.
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u/thatoneguy2252 Jul 09 '25
Insurances are awful. I was diagnosed with leukemia in May of 2023. Was told I’d need a bone marrow transplant and eventually my brother was tested to be the best match for me. Part of this process of him giving me his marrow was him going through the procedure to extract it and that’d be covered under my insurance. This was something that both of us checked with our insurances about and were told that it’s under my insurance since it was for me. The procedure took place that September and they are STILL trying to say it’s on my brothers insurance with Aetna and not mine which was BCBS at the time even today almost 2 years later
They’re all the same flavor of awful
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u/Cocosmil3 Jul 09 '25
So sorry. I feel for you with this bullshit. Insurance will do anything to deny a claim. It sounds like the birth will be under your wife’s insurance but the baby under yours. Certainly the hospital can bill UH. You will be on the phone with insurance. unfortunately they could deny because the baby was added after birth but I believe we did the same type of thing. I pray you can work this out.
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u/Remote_Focus_4521 Jul 09 '25
If the facilities are in-network it’s provider liability. Who cares!! Let them deal with it they can’t bill your wife more than any applicable copays / coinsurances
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u/katy_bug Jul 09 '25
No real advice, only sympathy. We are still dealing with insurance issues from my pregnancy and the birth of our younger daughter, who is now nearly 16 months old.
My best advice is just to document everything. Every phone call you make, the names of everyone you talk to, etc.
The system is broken. Good luck.
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u/rahah2023 Jul 09 '25
I had a hiccup back in the 90’s I had a baby & had insurance through work- I placed the baby for adoption so after he was born his adoptive parents added him to their insurance- then my insurance refused to cover delivery bc I didn’t add the baby to my insurance- had I added him even 1 month then moved his insurance they would have paid… my employer called and solved this and got the baby covered bc this information was never given to me & I had asked/checked with HR while pregnant
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u/Weird-Mall4577 Jul 09 '25
Congrats on your new baby. I’m sorry you are having to deal with this. This is what I know. The routine nursery charges are covered by mom’s insurance whether or not baby is added to mom’s plan. If baby is added to dad’s plan all other claims will be covered under Dad’s plan. I don’t know how to get the hospital to send the claim to mom’s plan.
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u/arctic_007 Jul 09 '25
Going through a similar issue with Blue Cross. It destroys you from the inside out. It’s just not fair.
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u/No-Side2837 Jul 09 '25
Contact your state department of insurance and/or file a complaint and they should reach out to all parties involved and help you through.
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u/sanityjanity Jul 09 '25
I'm confused.
If you login to UHC's website, can you get the EOB of your wife's charges, and then email/fax/upload those directly to Cigna?
Can you check to see if UHC *has* the baby's charges?
Can you login to the hospital's patient portal to get *their* billing information?
Part of the problem (I suspect) is that someone at Cigna isn't actually telling you what they need.
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u/mesposito94 Jul 10 '25
This stuff is very typical. The birth would be under your wives insurance. Any appointments for baby within the first 30 days would automatically be on her insurance even without calling or enrolling. After that baby needs to be on a plan with their own card. Any bills for baby within those 30 days would go to mom’s insurance. Then there is also the birthday rule
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u/Total_Bed53 Jul 10 '25
USA medical insurance system is complex especially if compared to many other countries systems. And I advice to Use one health insurance company for the whole family, if it's possible! Now, you have to know that you will have similar bureaucracy"problems" in the future with Property, Cars , life or any other insurance carriers, banks etc . You have to learn how to deal with them . The most important #1 is to Use emails and communicate in writing! #2 Ask for clear English speaking Supervisor ( they use out of USA customer service reps often ) Get step by step clear explanation in what to do to resolve your situation!!! Btw don't trust doctors 100% either and check Diagnosis, treatments , drug side effects etc on the Internet. Had to learn it hard way ! 95 % of info you can find by using basic internet AI search or basic Internet search engines!
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u/SwimmingAway2041 Jul 10 '25
My can feel my blood boiling when I read post like this about insurance companies because they’re all greedy and evil especially United I read a lot of bad stuff about that shit company. If the assholes at United are saying they never received anything on the baby ask the hospital why they can’t resend it tell them what the devil people at United told you that they never received anything. I wish the government would step in and make these insurance companies start paying the claims of their members but with the money those bastards have they’ll have plenty of lobbyists in Washington fighting that tooth and nail. Good luck getting anywhere with them
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u/jmp8910 Jul 11 '25
Ugh I dealt with something similar earlier this year because my little one was added to my insurance since it is better than my wife’s. Despite me telling EVERYONE at the hospital he was going on mine it still turned into a cluster duck. They don’t listen to you ever and assume it’s mom’s insurance. Then I had do deal with getting all the claims resubmitted to my insurance.
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u/nobodyyouknow96 Jul 11 '25
I’m not sure why anyone still has united healthcare, place is trash, wish everyone would switch providers so they can go under. They deserve it
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u/catcoil Jul 12 '25
By “everyone” do you mean employers bc people don’t have a choice most of the time
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u/Legal_Director_6247 Jul 12 '25
I believe it all depends on what customer service person you get. Keep calling until you get someone who will help you.
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u/Punkybrewsickle Jul 13 '25
I’ve worked in account management and service delivery for healthcare and health billing software for decades, specifically with ADP’s benefit services. I passed the PHR exam. And the CoB between my last plan and my secondary (turned primary) plan was non existent. I’ve moved/lost/started jobs a half dozen times and had benefits seamlessly transition without any hiccups. Not this time. Both of the major insurance companies did everything possible to kick the responsibility back onto the other. Citing new rules at each turn. Always disclaiming at the end of the call that it is the patent’s responsibility to oversee and facilitate the entire COB process. I spent almost a year chasing down reimbursement s for over $8k of covered expenses I had to pay out of pocket over and over.
I had to finally give up on the last couple thousand. They required manual submissions of every expense line by line, with unique forms of proof for each kind of care provider. Pharmacy payment history? physically print and signed by pharmacist and picked up in person by me. Then uploaded to glitchy web page. With no status updates ever. The hoops they made me jump thru back and forth (has to be a “loss of coverage letter” and the form couldn’t be called something else, even if all required info was included). I know more about this stuff than most benefited employees only because I have worked in these roles for 20 years, not because I paid more attention in orientations. And this broke me.
The weaponization of administrative burden is almost certain to be strategic. It’s a game of “not it” and disorientation designed to discourage—if not entirely impede—participants’ efforts to hold their plans accountable for reimbursing expenses we were forced to front them out of pocket. They count on people just paying cash at point of service when we’re informed that our insurance is yet again insisting it’s another insurance company's responsibility. And they count on it being so manual and disjointed that (x) percentage of policy holders will lag behind as the goose chase wears them down, or just give up completely. They are aware that “this should have a status update in 7-10 business days, if not then give the other insurance a call and see if they know how to help.” You wait the 10 business days for them to have no record of your inquiry. After a few months, you’re bound to miss one of the babysitting duties of shepherding them on through every step of their jobs. And when you inevitably do forget to chase them down for some status? It’s all your fault. I just gave up on $1k-$2k owed back to me from this evasive carrier that I drained from my savings, cuz every expense they can get you to absorb up front by withholding your coverage at time of service? They know 50-60% of the time, the patient realizes it’s futile to even bother. And so they don’t.
What angers me most is the number of providers that billed the new insurance without issue, the whole time. There was no grievous gross neglegence of reporting that compromised their database accuracy in their systems of record. These systems have every ability to verify --on the spot-- any active insurance you're covered by, if there is any. If the "other" plan has terminated, that can be confirmed in 30 seconds.
Insurance companies are in the business of denying claims, or at least stalling payments or steps for as long as possible knowns the patient will have to just give up. It's calculated, and scary.
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u/Beautiful-Couple-833 Jul 19 '25
Try looking into a group sharing plan. We did health zion and we only paid $1000... that was post birth check ups as well. We only found it because my husband lost his job last year and a friend suggested it. Feel free to dm me if you want if you have anymore questions
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u/RoundChampionship840 Jul 23 '25
Time to start filing complaints with your state department of insurance
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Jul 25 '25
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u/Electronic_Visual257 Jul 25 '25
From my experience, when there is anything slightly atypical insurance related, customer service is useless. The best way to go is thru your employer - HR people have direct contacts with customer service managers/heads od departments.. so go thru them. Claims typically get resolved this way much much faster. Good luck with everything!
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u/cilantropig 24d ago
I have some experience in this. I added my baby to my insurance shortly after born, I thought that's all done. Months later my insurance third party auditor called and claimed that during the first 30 days of baby was born, both mom and dad's insurance should cover the baby, and there is a "birthday rule", whoever's birthday is earlier (of the year) should be the primary and the other insurance is the secondary. So technically I should pay no deductible during the first 30 days for my child. In reality, my insurance that I already added my child to denied all claims and my husband's insurance (at the time) said they had no idea what we're talking about and ignored us. It took over two years, for all the claims either my insurance finally gave up paid the 80% or I think the provider just let it go. I didn't see any refund of my deductible I already paid. So you thought it might be better if both of your insurance cover first 30 days of your child health care automatically after birth, it actually became a limbo. I feel her, I was so mad each time I see another bill shows up from the child birth period. Hang in there, call your provider to explain the situation and have them resubmit insurance to your provider and call your insurance to escalate.
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u/Mguidr1 Jul 09 '25
My step daughter used midwives to deliver her two children and the experience was wonderful. The hospital and insurance system sucks in America. I have United healthcare but avoid using it if possible. I’ve never had a good experience with healthcare.
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u/Radiant2021 Jul 09 '25
I have UHC. They have hung up on me and also just ignore my claims so I dont have grounds to appeal. Insurance is scary. The whole goal is to deny.
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u/ReefJR65 Jul 10 '25
Why the fuck are we still allowing these middlemen to just take money from us, health insurance is such a scam.
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u/PBfromPhilly Jul 09 '25
Request to speak to the Claims Manager; if you get the run around, advise them that you will retain a lawyer AND will bring your case to social media and drag their names.
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u/leomaddox Jul 09 '25
Where to start. Begin In Writing. Make it look Legal. Stop talking to the clerks, their JOB is to wear you down. Next enrollment? All Family in One Plan. Sadly, You Double Paid in premiums (single people always pay more). I’m sorry. Direct Correspondence to ACCOUNTS PAYABLE, make Several Copies, and register mail them. I’m not a lawyer or a doctor. Just had my own bad experiences with Healthcare Insurance Companies. And CC The Hospital.
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u/melonheadorion1 Jul 09 '25
Everything said here is just wrong
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u/Superb_Narwhal6101 Jul 09 '25
So so wrong.
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u/leomaddox Jul 09 '25
Do Tell. What should he do? He has a New Baby, no sleep and an overwrought wife. Tell us
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u/CancelAshamed1310 Jul 09 '25
What on earth? Are you ok?
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u/leomaddox Jul 09 '25 edited Jul 09 '25
Yes. I did this for my family-specifically my son. He has Crohn’s. It’s not necessary to downvote me or insult me. It worked. Guess who’s coming for this family next? Credit companies. OR, Pay The Bill. Give some concrete suggestions, people.downvote me does Nothing for the OP.
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u/melonheadorion1 Jul 09 '25
People already have. None of it has to do with any suggestion that you gave. The fix is so much simpler than anything you provided
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u/Superb_Narwhal6101 Jul 09 '25
Um? What are you talking about? Do you have any experience actually working in the insurance industry? Because that made zero sense.
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u/leomaddox Jul 09 '25
NO. My son has two plans, we were divorced at the time of his diagnosis (2019). If You have solutions, please spell them out. I would like to learn them too.
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u/Mother_Goat1541 Jul 09 '25
OP, don’t do any of this
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u/leomaddox Jul 09 '25
What should he do?
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u/Intelligent_Fee5011 Jul 09 '25
I had a similar issue with the birth of my son. Both insurance companies were claiming that other should pay, the hospital knew one of them would eventually pay and were quite patient for about a year. I finally gave up dealing with them and contacted my state insurance commission with my problem. Funny, they both quickly got their shit together after the state got involved.
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u/Mother_Goat1541 Jul 09 '25
Talk to the insurance companies, determine which is primary according to birthday rule, and make sure they’ve filed the necessary forms to notify the insurance companies of each other.
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