Help me understand if my hospital bill for birth is appropriate.

Hello,

I had finally grasped how health insurance works in terms of deductibles, OOP max, etc a few years ago when I started having health problems and always reached my OOP max. I recently had a baby and have some questions regarding if the bill I'm receiving for the baby is appropriate.

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I reached my OOP max in June of 2022 and had my baby in December 2022. Having read a few threads about cost of delivery, some had responses saying the cost of having the baby was $0 because the patient had already reached OOP max for the year. Reading this and also hearing that the "baby is covered by Mom's insurance the first 30 days" I was expecting to pay $0 for delivering the baby and baby's health since I had her at the end of the year and had already reached OOP max a few months prior.

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However, I received a bill under my baby's name with my responsibility of ~$500 (which is each person's deductible under my plan). I know the baby is her own person now to receive bills but am I incorrect in assuming that her care for the first 30 days, especially the delivery, would've been covered under my plan because she didn't have her insurance in place yet when she was born? For what it's worth, all my care for delivery, etc. is $0 because of reaching OOP max already. I'm just confused how some other people have said they paid $0 for their child's birth after reaching OOP max when it looks like the hospital billed my baby for the birth/care. I've heard the insurance is retroactive to baby's birth, does that mean all of my (me+baby) deductible/OOP max was reset to when she was born because the she was retroactively added as an individual to my insurance plan?

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Sorry if this is a dumb question but I just wanted some clarification as to if I should appeal this with my insurance company or not. I did appeal with my insurance company a while ago but the appeal was denied and I still don't understand the lingo reason as to why the appeal was denied. I also called the hospital billing department and they had no clue as to how we were billed but only knew what the insurance covered vs what I owed. I also received another bill from the hospital for my baby which shows the contractual insurance payment and what I owe but I don't see this claim under my insurance (either under my name or the baby's) and have no EOB for the second bill. It was pharmacy charges, etc for my baby so do I call the hospital or the insurance company or both for the bill that's showing up in my hospital portal but does not show up on my insurance portal.

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Lastly, I also had to do some genetic testing during pregnancy. I got an estimate from the genetic testing company that said I would owe $0 towards the test because my insurance covers it. Now, about 6-8 months later, I'm receiving a bill for $400 from the genetic testing company saying I'm responsible for this amount. How do I fight this charge because I agreed to the test on the pretext that my responsibility would've been $0.

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Thank you in advance for helping a noob navigate the complexities of the health insurance system!

submitted by /u/pelotauntmylungs
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