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x_harmoni_x · Feb 19, 2008, 08:28 PM

I am being sued by the hospital that I gave birth to my son in. My insurance company refused to pay for his nursery care so now they are suing me. What is the statute of limitations in NY? I am looking into whether I can sue the insurance company.

JudyKayTee · Feb 20, 2008, 07:12 AM

Originally Posted by x_harmoni_x

I am being sued by the hospital that I gave birth to my son in. My insurance company refused to pay for his nursery care so now they are suing me. What is the statute of limitations in NY? I am looking into whether or not I can sue the insurance company.

It's 6 years in NYS - before you sue them I'd go through the insurance company appeal process (if you haven't already done so).

What basis did they give for their refusal? They paid for the delivery but not the nursery care - ?

x_harmoni_x · Feb 20, 2008, 08:44 AM

My 2 posts sound similar but this one is asking about me suing the insurance company and the other one is about the hospital suing me and if they pass a judgement what happens.

The insurance covered all my maternity costs, labor and delivery but refused to pay my son's nursery bill because I was on my mother's insurance. The told my mother that she would have to adopt him for them to cover anything.

I am trying to look into NYS health insurance laws to see if I can fight this. There was no way I could have had other insurance for my son while he was in utero.

JudyKayTee · Feb 20, 2008, 09:07 AM

Originally Posted by x_harmoni_x

My 2 posts sound similar but this one is asking about me suing the insurance company and the other one is about the hospital suing me and if they pass a judgement what happens.

The insurance covered all my maternity costs, labor and delivery but refused to pay my son's nursery bill because I was on my mother's insurance. The told my mother that she would have to adopt him for them to cover anything.

I am trying to look into NYS health insurance laws to see if I can fight this. There was no way I could have had other insurance for my son while he was in utero.

Okay, I understand the 2 posts -

I "believe" that your son's expenses are excluded from your health insurance unless you carry some type of family plan and it would not appear that you do not.

I still would file the appeal with the insurance company but my guess would be that they are going to quote the language in the policy.

x_harmoni_x · Feb 20, 2008, 09:14 AM

My mother's insurance was a family plan. It was for employee and dependent children. I found a NYS law that may state it, but I'm not sure. I'm not very good with legalize.
The law is New York Insurance Law § 4303(c)(1)

My other question is, if I start sending them money now can they still sue me?

Thanks for answering all my questions!

JudyKayTee · Feb 20, 2008, 11:06 AM

Originally Posted by x_harmoni_x

My mother's insurance was a family plan. it was for employee and dependent children. I found a NYS law that may state it, but I'm not sure. I'm not very good with legalize.
the law is New York Insurance Law § 4303(c)(1)

My other question is, if I start sending them money now can they still sue me?

Thanks for answering all my questions!

The plan appears to cover your mother - the employee - and HER dependent children. Your child is not one of her dependent children. That section is addressing an insured mother with insurance on an unborn/born child, for example what is called "family insurance" - not your situation where YOU are a dependent but not your child. (Am I explaining this clearly? If not, let me know.)

Yes, they can still sue you - you would have to make an agreement with them for, say, so much a week or so much a month. I always recommend a WRITTEN agreement so there are no problems - and then you would have to make the payments as scheduled.

I know in some cases people have been able to negotiate the debt to a lower amount but I don't know if a hospital would accept that. I'm surprised the hospital didn't see that this could be a problem and refer you to one of the other insurance programs, for example, Healthy New York or something similar.

Will your baby's father take some responsibility? That might take some of the heat off you.

x_harmoni_x · Feb 20, 2008, 11:18 AM

Thanks for all the advice. I called a lawyer and I am going to make a consultation appt and see what he tells me. The hospital tacked on over $1,000 in interest so I'/m going to see if they will drop the interest and if I could pay the original bill.

JudyKayTee · Feb 20, 2008, 11:23 AM

Originally Posted by x_harmoni_x

Thanks for all the advice. I called a lawyer and I am going to make a consultation appt and see what he tells me. The hospital tacked on over $1,000 in interest so I'/m going to see if they will drop the interest and if i could pay the original bill.

Excellent - and I'm sure you looked into this but be SURE what the Attorney's fee will be before you go in. Sometimes the consultation fee can be pretty staggering.

If it's a good Attorney he/she should be able to negotiate the bill down enough that you can pay his/her bill and still come out ahead!

Good luck!

ScottGem · Feb 20, 2008, 11:27 AM

Was NOTHING said about this when you were admitted to the hospital? Did you go for any pre screenings where this could have been mentioned? I find it hard to believe this issue never came up, its not as if you didn't know you were going to be in the hospital for a time.

x_harmoni_x · Feb 20, 2008, 11:47 AM

Originally Posted by ScottGem

Was NOTHING said about this when you were admitted to the hospital? Did you go for any pre screenings where this could have been mentioned? I find it hard to believe this issue never came up, its not as if you didn't know you were going to be in the hospital for a time.

Nope. They did tell me anything until after he was born and we got a bill 2 weeks later. I was told on the phone when I was about 3 months pregnant that he would be covered for 30 days after I gave birth, but of course I was young and stupid then and didn't get anything in writing to prove what I was told.

ScottGem · Feb 20, 2008, 12:05 PM

I would tell them to sue you and go into court and tell the judge that the hospital made no mention about this being an issue. I think the judge will throw out their suit.

JudyKayTee · Feb 20, 2008, 12:07 PM

Originally Posted by ScottGem

I would tell them to sue you and go into court and tell the judge that the hospital made no mention about this being an issue. I think the judge will throw out their suit.

Have you talked to a hospital social worker - and maybe your Attorney will take care of that for you.

They SHOULD have verified your health insurance and they SHOULD have realized the baby would not be covered and they SHOULD have offered alternative suggestions.

In a perfect World, of course, but it might be worth taking a shot at that aspect.

x_harmoni_x · Feb 20, 2008, 12:08 PM

Originally Posted by ScottGem

I would tell them to sue you and go into court and tell the judge that the hospital made no mention about this being an issue. I think the judge will throw out their suit.

Is it a law for them to tell me that the baby wouldn't be covered? What kind of proof do I have that they didn't tell me? Maybe the hospital didn't even know. This whole situation is screwed up. The insurance company told me he would be covered and then didn't cover him and I wasn't able to get him child health plus until he was almost 6 months old.

x_harmoni_x · Feb 20, 2008, 12:12 PM

Originally Posted by JudyKayTee

Have you talked to a hospital social worker - and maybe your Attorney will take care of that for you.

They SHOULD have verified your health insurance and they SHOULD have realized the baby would not be covered and they SHOULD have offered alternative suggestions.

In a perfect World, of course, but it might be worth taking a shot at that aspect.

The social worker only came and spoke to use once about statutory rape. That's it. And they were suppose to follow up with me and help me get insurance for my son after I went home, but they never did.

I'm pretty sure the lawyer I called has free consultation. I am waiting for them to call back, but I will be sure to ask.

Besides all of this, this hospital almost killed me and my child. They refused to give me a c-section after being in labor for 2 days. I ended up needing 2 blood transfusions from tearing and my son had fetal stress.

JudyKayTee · Feb 20, 2008, 12:58 PM

Originally Posted by x_harmoni_x

Is it a law for them to tell me that the baby wouldnt be covered? What kind of proof do I have that they didnt tell me? Maybe the hospital didnt even know. This whole situation is screwed up. The insurance company told me he would be covered and then didnt cover him and I wasnt able to get him child health plus until he was almost 6 months old.

Unfortunately, no, there is no such law - they "probably" made a mistake. And, no, you don't have any proof.

I'm surprised they didn't check but a lot of things surprise me.

Sounds like a mess but you are working your way through it.

ScottGem · Feb 20, 2008, 05:42 PM

I'm not so sure that there isn't some law that covers this. Does the hospital have a Patient's Bill of Rights? Any hospital stay is supposed to be pre-approved by the insurer. Therefore you should have been informed if any services weren't covered. If the insurer told the hospital it would be covered and reneged, they could be liable.

The thing is, I think, if they tried to sue you and couldn't prove that they told you the nursery care wouldn't be covered then I don't think any judge is going to award them the fees. If they do, you really aren't much worse off, so its worth a shot.

raku · Feb 21, 2008, 05:45 AM

I am giving birth next month and I am having a problem getting these kinds of answers from my insurance company. Nothing is in writing and the people who you talk to on the phone pretend that they know what they're talking about but don't. So your situation does not surprise me at all. Contact the New York State insurance board. They can find out if New York State Law applies to your plan and may intervene on your behalf. According to New York state law if the insurance covers maternity care, they must cover the first 48 hours of inpatient care for you and your infant. After that they are only required to offer limited coverage for your child for the first 30 days. If you're not in New York, check your state law or you may be covered by federal law. Good luckl!

x_harmoni_x · Feb 21, 2008, 08:58 AM

Originally Posted by raku

I am giving birth next month and I am having a problem getting these kinds of answers from my insurance company. Nothing is in writing and the people who you talk to on the phone pretend that they know what they're talking about but don't. So your situation does not surprise me at all. Contact the New York State insurance board. They can find out if New York State Law applies to your plan and may intervene on your behalf. According to New York state law if the insurance covers maternity care, they must cover the first 48 hours of inpatient care for you and your infant. After that they are only required to offer limited coverage for your child for the first 30 days. If you're not in New York, check your state law or you may be covered by federal law. Good luckl!

Thanks! I did find that law too. I sent an email to NYS and I don't think they understood my question.

I wrote:
"I was 16 when I had my son and covered under my mother's health insuranceplan which was a PPO. They covered all my maternity costs, but denied thenursery care and costs of my son. There was no way I could have gotten himother insurance since I was covered by my mother's insurance.Is what they did legal?"

They responded with:
"There is nothing in the Insurance Law that says an insurance company has toenroll a dependents child. If you have not already done so you may wish tolook into getting Child Health Plus coverage for your child. You can findmore information on Child Health Plus by calling 1-800-698-4543"

They didn't really answer my question because I wasn't trying to enroll him. But how could I have gotten him different insurance while in utero?

ScottGem · Feb 21, 2008, 09:03 AM

Did you contact Child Health Plus? The people there may give you some insights on what should have been done.

JudyKayTee · Feb 21, 2008, 09:17 AM

Originally Posted by raku

I am giving birth next month and I am having a problem getting these kinds of answers from my insurance company. Nothing is in writing and the people who you talk to on the phone pretend that they know what they're talking about but don't. So your situation does not surprise me at all. Contact the New York State insurance board. They can find out if New York State Law applies to your plan and may intervene on your behalf. According to New York state law if the insurance covers maternity care, they must cover the first 48 hours of inpatient care for you and your infant. After that they are only required to offer limited coverage for your child for the first 30 days. If you're not in New York, check your state law or you may be covered by federal law. Good luckl!

I think you are misquoting NYS insurance law - this person is a dependent covered under her mother's insurance, she does not have her own insurance and I believe the law does not follow through to dependent grandchildren.

To a certain extent I am surprised that it has covered this person's childbirth expenses because that is often an exclusion - but, then again, I don't know the circumstances or the policy wording.