Jessica Rapp and Jake Irwin are having to pay $5,000 more for the birth of their son, Jack, because of a little-known Colorado insurance law, simply because of when their birthdays occur in the calendar year.
Jack was born last August without any complications and they only stayed at the hospital for two nights. Now, Jessica says that due to a law called the "birthday rule" those two nights were going to cost her family $5,000 more.
According to the "birthday rule," if each parent has separate insurance, the newborn has to be covered under the parent whose birthday falls earliest in the calendar year. Jake's birthday is in January and Jessica's birthday is a month later, so Jack had to automatically be covered under his father. Unfortunately, Jack's insurance didn't cover as much as his wife's insurance would have and now the new parents are exploring the option of a three-year payment plan simply to pay off the birth of their son.
Jake says that it seems to be “Completely arbitrary," and that, “If we have one insurance, that seems to be fine, but the fact that we have two insurances and are almost at fault for that we’re being charged more doesn’t make sense.”
Jessica says, "We had never heard about it before. It was never mentioned at any prenatal appointments with my doctor, or my phone calls with the insurance company beforehand, or my employer benefits representative; I don’t know whose job it should be to tell people about this, but I feel like it needs to be passed on somehow.”
The rule apparently started in the 70s (according to the Colorado Department of Regulatory Agencies Divison of Insurance) as a way to ensure a newborn would be covered.
According to Vincent Plymell, Assistant Commissioner for the division, "When it came about, it probably envisioned that the two parents with their employer-based insurance plans, probably would have very similar plans. Obviously, we know that’s not the case, it’s very common for people – even similarly situated people – to have very different plans, often even within the same company. So, I could see where there could be some sort of feeling like a mismatch between the two parents employers' plans.”
Vincent says that there’s no way for expecting families to get around the rule for the initial birth, but parents can petition to change the insurance coverage for the baby within 30 days of the birth for any future medical expenses. He says, "One thing I would throw out to people is if they run into a problem regarding coverage – whether it’s related to the newborn or the birthday rule or not – if they feel that something’s amiss, something’s not right, to contact the Division of Insurance, even when rules are supposed to be followed and done in this way or that, mistakes are made. Sometimes it’s human error, sometimes it’s a system error, sometimes it’s a computer thing, and it’s worth asking the question; there is no cost to contact us and find out ‘hey what were things done correctly?'”
The division has only received five complaints over the last two years regarding insurance coverage for newborns, and two of those complaints were related specifically to the birthday rule.
Vincent claims that the rule is tough to change because there needs to be a default plan in place to ensure a newborn has coverage. He says, "What’s the right rule? Is that a birthday rule, is it something else. You have to land on something, to ensure that newborn is covered.”
Jake and Jessica are hoping that the law gets a second look with Jessica stating, “I truly think there should be a choice. I’m the one who had the baby, and I feel like as the mother, I should have a say in whether he is covered under my insurance plan or not… It just feels like as a new mom, to not be able to choose something so big about my baby seems like kind of like a right that I should have, that I don’t. So that’s been kind of frustrating and upsetting, and if the rule is going to stand, at least educate and make people aware of it beforehand, so they can prepare.”
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