'Birthday rule' leaves parents with $270K hospital bill

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A little-known rule that stipulates a child born with double health insurance eligibility must be enrolled in the plan belonging to the parent whose birthday comes first in the calendar year can induce outrageously expensive bills for parents who are unaware of it, according to a Jan. 27 NPR report.

This regulation, known as the "birthday rule," was established by the National Association of Insurance Commissioners and adopted by most states, according to Lee Modesitt, the Kansas Insurance Department's director of government affairs.

The birthday rule determines which insurance will be primary for the child and which will be secondary, but premiums, deductibles and networks often vary greatly between both parents' insurance plans, so parents don't always have the option to make the more comprehensive plan their child's primary insurance.

This rule resulted in new parents, Kayla and Mikkel Kjelshus, receiving a bill from HCA Overland Park (Kan.) Regional Medical Center totaling $270,951. The charge included $207,455 for an NICU stay. 

After negotiating with insurers to pay the balance and getting in touch with the hospital, the bill was changed to a zero balance. 

"We made an administrative error and an automated billing call system for payment occurred, causing the family undue frustration during an already stressful time, and we apologize," the hospital wrote in a statement to NPR. "Once the issue was identified and resolved, the insurance companies processed the claim and we informed the family that there is a zero balance on the account. Again, we are sorry for the stress and inconvenience, and wish them well."

 More articles on healthcare finance:
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