Newborn Claim Mess

Our son was born 6/5, procedure took place 6/17 at doctors office. State of FL.

Wife and I each have our own individual plans through our employers. We notified Cigna (wife’s insurerer) prior to the birth of this planned procedure and were told the procedure would be covered and we’d be responsible for 10%. She had met her deductible as of the birth at the hospital, and on that call with Cigna that’s how the 90/10 coverage number came about.

We paid the doctor OOP for the procedure and filed a claim with Cigna. My wife called Cigna and they walked her thru how to fill out the claim form (with the intention of this being covered within the 30-day newborn coverage under Mom’s policy). Cigna processes the claim under Mom’s name.

At day 31 newborn is added to Dads policy (BCBS). BCBS requires a notice of release of coverage from Cigna. Wife calls and Cigna provides this—newborn added to BCBS on family plan on 7/6.

Today we call the doctor for an update on payment from Cigna so we can get our reimbursement. Doctor informs us that while Cigna paid the original claim in Moms name, they’ve now put in a refund request for that claim and have submitted a new claim in the newborns name (which would be $0 from Cigna, as the newborn would now have his own deductible, which would be un-met).

Speaking with Cigna, they state that per our notification of the birth they on their own convert my wife’s plan to a family plan and that she filled out the claim form wrong in the process. They’ve opened a “Misquote” review and are pulling the phone calls recorded to see if one of their reps miscommunicated anything. Other than that they stand behind this needing to be processed as a Family Plan claim with a new deductible.

I’m lost—and we believed that the first 30 days would be covered under my wife’s plan (individual) AND deductible. Feels very deceiving and “semanticy”.