NICU Bill and Birthday Rule

Insurance claims denial questions here. My son was born a few months ago and went to the NICU due to multiple complications. He was enrolled under my plan through my employer within the first 30 days after birth. His bill has been denied by insurance multiple times for multiple reasons.

First denial was due to lack of timely filing from the hospital. The hospital claimed they didn't know insurance coverage but it had been provided to them and we confirmed baby was enrolled on time. We spoke with insurance and they "discovered" their timely filing limit was actually longer and reprocessed the claim.

Second denial was due to a lack of prior authorization. We pointed out that there could not be a prior authorization completed for an emergency situation right at birth and they submitted claim for reprocessing. For a time the claim said pending and had an amount we would owe that was up to deductible/out of pocket max.

Now received third denial notice – insurance says another primary coverage was detected. My son was never officially enrolled by us in my husband's insurance plan but apparently his insurance auto-enrolls infants for the first 31 days. Of course due to birthday rule my husband's insurance is considered primary and has much higher deductible/OOP max than mine does. His insurance is with the same carrier as mine so I'm not sure how this was just now detected other than that insurance is looking for every way possible to deny this bill. I wish we had known about the birthday rule prior to all of this but unfortunately were completely ignorant.

My questions are as follows: 1. Can insurance now deny any claims processed through my husband's insurance due to lack of timely filing since the birth/NICU stay were at the end of 2023? 2. If that happens, will bill then go to be processed through secondary insurance or can they also deny it if primary does? 3. Will we then be responsible for paying the full bill? Thanks for all help, this has been the most stressful process and reinforced my belief that insurance companies truly are the bad guys.

submitted by /u/Dry-Indication-6485
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