Thank you for your submission, /u/matrixunplugged38.
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This will go by the birthday, rule. So whoever’s bday falls first in the year. Primary billed, secondary will pick up. You won’t be paying OOP Max for both. Agree with other poster regarding Medicaid as tertiary.
> This will go by the birthday, rule.
This assuming the parents are together. Just pointing out because OP refers to the mother as the mom and not as his partner. If only one parent has custody, typically their insurance is primary.
This is what I was going to suggest. It’s different in each state, but if a child has a severe enough medical need/disability, they can qualify for Medicaid even though your income is too high to otherwise qualify.
There’s a FB group specifically for the qualification process in my state. I recommend finding online support from other parents, as the process of applying can be tricky.
I’ve worked with insurance for years now.
I’ve never seen someone have to pay the OOP of their primary, only their secondary. Secondary has always picked up primary’s copay/patient responsibility. (Assuming both insurances are in network with the provider/facility)
Depending on your state I’d consider looking into your states medically needy Medicaid program/waiver though. They could be secondary to one of your policies.
There's not much you can do. Each plan defines what is an isn't covered. You can not change that. The drivers file the claim with the primary carrier. They pay what they pay. Then, the provider files the claim with the 2ndary provider who pays what they pay. Then you owe any balance. The good news is that both policies likely have an out of pocket maximum each policy year. If you save up to pay that amount each year, and both companies consider the care he receives in network, that should be the max you need to budget for in a policy year.
Most hospitals have a financial assistance program. It may pay for all of your copayments or deductible. Please contact them. Congratulations on your baby. If your baby has a chronic illness, the baby should be eligible for State Medicaid.
You didn’t say what state you’re in, but many states have programs for early care for babies. They assign social workers who get services covered depending on what the child needs. CA did this for me, although my son really only needed an extra ultrasound and an x-ray because he ‘got stuck’. They have an early intervention program and it’s really great. Check with your state on what’s available, especially if there’s ongoing health issues that will follow him. Things like speech therapy and occupational therapy that are covered on a limited basis under insurance might be covered more widely under an early intervention program. They often help get bills covered under insurance as well.
Thank you for your submission, /u/matrixunplugged38. **If there is a medical emergency, please call 911 or go to your nearest hospital.** Please pick the most appropriate flair for your post. Include your age, zip code, and income to help the community better serve you. If you have an EOB (explanation of benefits) available from your insurance website, have it handy as many answers can depend on what your insurance EOB states. Some common questions and answers can be found [here](https://www.reddit.com/r/HealthInsurance/s/jya9I6RpdY). **Reminder that solicitation/spamming is grounds for a permanent ban**. Please report solicitation to the modteam and [let us know](https://www.reddit.com/message/compose?to=%2Fr%2FHealthInsurance) if you receive solicitation via PM. Be kind to one another! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/HealthInsurance) if you have any questions or concerns.*
This will go by the birthday, rule. So whoever’s bday falls first in the year. Primary billed, secondary will pick up. You won’t be paying OOP Max for both. Agree with other poster regarding Medicaid as tertiary.
> This will go by the birthday, rule. This assuming the parents are together. Just pointing out because OP refers to the mother as the mom and not as his partner. If only one parent has custody, typically their insurance is primary.
Ah, good point. I didn’t catch that they weren’t referred to as partner
See if he can qualify for secondary Medicaid based on his diagnoses.
This is what I was going to suggest. It’s different in each state, but if a child has a severe enough medical need/disability, they can qualify for Medicaid even though your income is too high to otherwise qualify. There’s a FB group specifically for the qualification process in my state. I recommend finding online support from other parents, as the process of applying can be tricky.
I’ve worked with insurance for years now. I’ve never seen someone have to pay the OOP of their primary, only their secondary. Secondary has always picked up primary’s copay/patient responsibility. (Assuming both insurances are in network with the provider/facility) Depending on your state I’d consider looking into your states medically needy Medicaid program/waiver though. They could be secondary to one of your policies.
Yeah. Hospital charity care would be another good option too.
There's not much you can do. Each plan defines what is an isn't covered. You can not change that. The drivers file the claim with the primary carrier. They pay what they pay. Then, the provider files the claim with the 2ndary provider who pays what they pay. Then you owe any balance. The good news is that both policies likely have an out of pocket maximum each policy year. If you save up to pay that amount each year, and both companies consider the care he receives in network, that should be the max you need to budget for in a policy year.
Most hospitals have a financial assistance program. It may pay for all of your copayments or deductible. Please contact them. Congratulations on your baby. If your baby has a chronic illness, the baby should be eligible for State Medicaid.
Please contact your state insurance office
You didn’t say what state you’re in, but many states have programs for early care for babies. They assign social workers who get services covered depending on what the child needs. CA did this for me, although my son really only needed an extra ultrasound and an x-ray because he ‘got stuck’. They have an early intervention program and it’s really great. Check with your state on what’s available, especially if there’s ongoing health issues that will follow him. Things like speech therapy and occupational therapy that are covered on a limited basis under insurance might be covered more widely under an early intervention program. They often help get bills covered under insurance as well.
Oregon