OLATHE, Kan. — Expecting and new parents, this may affect you. It’s called the “birthday rule.”
Kansas Rep. Sharice Davids (D) introduced legislation last week hoping to make the process easier when the rule applies to families.
It’s a long-standing practice by insurance companies. When both parents have separate insurance and a baby needs care at birth, in some states they will bill the parent’s insurance who has the earlier birthday. Even if it’s not what parents planned on.
The birth of 2-year-old Charlie was a blessing for the Kjelshus family, but immediately she struggled.
“When she came out she had a low oxygen level and difficulty breathing. Right away we knew there was something not right here,” mom Kayla Kjelshus said.
Charlie was transferred from St. Luke’s Medical Center to Overland Park Regional Medical Center. After a week, baby Charlie came home, and so did the bills. About $7,000 more than they expected. In total, insurance did cover most of the more than $200,000 medical costs for the stay.
“We were the ones that truly had to go, ‘OK, this is what’s happened so far. What do we need to do about it?’ Navigating that was extremely difficult,” Kayla said.
The couple prepared for Charlie before she was born. Kayla contacted her insurance, Blue Cross Blue Shield of Kansas City, before she was born and told them they wanted her on Kayla’s plan.
However, due to the birthday rule she ended up on her husband’s, Mikkel Kjelhsus, because his birthday was two weeks before his wife’s. Unfortunately, his insurance was out of state and out of network.
“It benefits the insurance company, absolutely. Obviously, we want to choose to have our child under a better healthcare provider, but they didn’t. They chose mine versus my wife’s,” Mikkel said.
Davids is taking on the rule in Washington D.C. Recently, she introduced legislation that would give parents 60 days to choose which insurance they want their baby to be under. If not, the birthday rule would apply.
“We just want to make sure that folks don’t end up with surprise medical bills, with frustrating back and forth with insurance companies and their providers. This is hopefully going to be helpful for all of all of the new parents out there,” Davids said.
The Kjelshus’ support the legislation. They have a new baby on the way and are hoping everything will go smoothly, but if they need help again — they know the birthday rule could be in effect.
“I thought it was the craziest thing. The more you learn about it because there’s not a lot of information about it,” Mikkel said.
“This is a decision that should be up to families. Up to parents. I don’t think that the insurance governing body should force you into who covers your child and who doesn’t. This should be a decision we get to make,” Kayla said. “Don’t ever give up. Keep asking questions, and you keep trying to figure out what needs to be done.”
FOX4 reached out to HCA Medical about the Kjelshus’ situation, and they provided the following statement:
“Overland Park Regional Medical Center provides financial counselors to guide patients and their family on insurance coverage, benefits and available financial resources as a part of the admission process,” says Christine Hamele, HCA Midwest Health Spokeswoman. “This includes confirming with the patient or their family their insurance policy, hospital benefits, co-payments, etc.
In this case the hospital was not initially made aware that the patient had two insurance plans. Once this information was made available, we filed with each insurance carrier, as hospitals are required. It is up to those carriers to coordinate coverage and reimbursement. This process resulted in a longer period of time than anticipated.
In the meantime, we made an administrative error and an automated billing call system for payment occurred, causing the family undue frustration during an already stressful time, and we apologized. Once the issue was identified and resolved, the insurance companies processed the claim. The couple ultimately paid a total of $2,340.94 to the hospital and there is a zero balance on the account. Again, we are sorry for the stress and inconvenience and wish them well.”
FOX4 reached out to Blue KC, but did not hear back.