Colorado Family Faces Insurance Battles Due to Birthday Rule

A Colorado family recently shared their experience of grappling with two insurance companies over medical expenses, highlighting a little-known rule that complicated things. Last month, CBS Colorado featured a family struggling with the same issue regarding their son’s NICU stay, caused by the confusing “birthday rule” concerning which parent’s insurance should take precedence. Now, Stephanie Hudson and Andrew Feeney are facing similar challenges.

Bringing their baby Brody home was meant to mark the end of a challenging period in the NICU. Stephanie thought she was handling the situation well during such a taxing time. “I believed I was doing everything right,” she reflected.

Shortly after Brody’s birth, Stephanie enrolled him in her employer-sponsored health insurance, anticipating high hospital bills. For a while, everything seemed covered until unexpected notices began to arrive.

“Initially, our insurance covered the claim and then later reimbursed us,” Stephanie explained. “That was quite a surprise and not an easy one to navigate.” They soon discovered the specifics of Colorado’s “birthday rule,” which permits parents to select whose insurance will be primary for their newborn. If both parents are insured, the newborn defaults to the parent whose birthday comes first in the calendar year.

Andrew expressed frustration that no one informed them about this rule before or after Brody’s birth. “I attended a class presented by my father and even toured the hospital,” he recalled. “We thought we were ready as first-time parents, but nobody mentioned the importance of ensuring proper insurance coverage.”

As it turns out, Andrew’s birthday falls at the beginning of the year, which has posed complications. Although he received compensation from Group Management Services (GMS), the company continues to deny claims, arguing that the birthday rule doesn’t apply in this situation.

“GMS claims that decisions on interest adjustments rely on governing documents and the specifics of the case,” the company stated. Andrew feels a sense of defeat. “We should have had proper insurance in place. I only paid the premium once. Why is that on me?”

The Colorado Department of Insurance has clarified that the birthday rule is designed to avert issues like the ones the couple faced. They noted that they’re reviewing current regulations to see if parents could select an insurance plan that would cover newborns for the first 30 days, though this is still in the early discussion stages.

“There needs to be more education across Colorado’s hospitals,” Stephanie asserted. “It’s a simple issue that can lead to significant problems, all of which are entirely preventable.” The couple has found that months of anxiety and countless phone calls have overshadowed what should have been a joyful time.

Andrew remarked, “Honestly, dealing with the insurance was worse than the NICU experience. The NICU staff were wonderful; the insurance interactions were just dreadful.” GMS informed CBS Colorado that it could not reveal specifics about the claim denial due to privacy concerns. The U.S. Department of Labor is currently looking into the matter.