New Parents Caught In Confusion Over 'Birthday Rule'
By Libby Smith
BLACKHAWK, Colo (CBS4) - A Colorado couple was caught in the middle of two insurance companies and a big hospital bill, when they couldn't get action on their own, they asked CBS4 to get involved.
At just 5-months old, Winnie has already racked up some pretty big medical bills.
"One of the nurses happened to notice that she looked yellow, and sure enough she had jaundice," said Carmen Kopen, Winnie's mom.
Within hours of being born, Winnie went into the neo-natal intensive care unit. For 3-days she was under lights and a bilirubin blanket to treat the jaundice, at a cost of $17,007.79.
"So we signed her up for Anthem, my insurance, within the deadline which is 30-days after she's born," Carmen explained.
Anthem denied the claim, saying, "The member is eligible for health care benefits with another health insurance carrier."
"We just went back and forth and back and forth for a very long time," Carmen told CBS4.
RELATED: Colorado's Birthday Rule
Anthem cited the Newborn State Mandate, a Colorado regulation that says when a child has access to insurance through both parents, the plan "of the parent whose birthday falls earlier in the calendar year is the primary plan," whether or not the child is enrolled with that insurance company.
"Their argument is because Jason's birthday comes before mine in the calendar year, that his insurance company has to serve as primary," Carmen said.
Jason is Carmen's husband, and Winnie's father. His insurance is Aetna, who also denied the claim. Aetna said that Winnie wasn't a member. So the Koplan's went back to Anthem where Winnie is a member and again got denied.
"And they kind of wear down your resolve because you just get so frustrated," Carmen said.
The couple went round-and-round, with many e-mail exchanges and long phone calls. The couple worried they might get stuck with the bill.
"We would have to sell our house," Jason said of having to fulfill that obligation.
The couple reached out to CBS4 and within two-days Aetna cleared the red tape, and paid the bill.
"You guys being involved and looking into it is what made the difference," said Jason Kopen. "We don't worry anymore about potential bankruptcy or financial ruin or anything."
Libby Smith is a Special Projects Producer at CBS4. If you have a story you'd like to tell CBS4 about, call 303-863-TIPS (8477) or visit the News Tips section.
