One of the most joyful times in the life of parents is the birth of their first child. Meeting a tiny baby for the first time is a life-changing moment. That baby will bring grandparents, aunts, uncles, and friends together in a special way. Everyone celebrates and supports the first-time parents in their new journey.
The last thing that should ruin this joyful experience is “surprise billing,” but for some first-time parents, that is exactly what happens. It usually happens to new parents whose baby is born with medical issues that require time in the hospital, and possible tests and/or surgeries before the baby can go home. When babies cannot go home as planned, it is often a stressful event for the new parents. They worry about their baby’s health, how to care for them upon discharge, and the normal anxiety of new parents. And while new parents are especially vulnerable to getting caught in the “birthday rule,” anyone can get caught.
For these new parents who picked between their two health insurance plans ahead of time to identify which insurance plan to add the baby to, they are probably fine. They likely picked the insurance plan with more generous primary care coverage for the baby. For parents who had not yet identified which plan to select (maybe the baby arrived early, or they were unaware that they needed to select between the two plans, or they were simply too busy to pick one plan), health care becomes a game of chance.
Under current law, when parents both have individual health insurance coverage but have not yet decided which plan to use for their new child, a default kicks in: The parent whose birthday comes first in the calendar year covers the new baby with their health insurance plan, regardless of whether it’s the best plan. This default is known as the “birthday rule.”
If the baby needs expensive medical care at birth — and in the days and weeks afterward — the parents could receive surprise medical bills in the tens or hundreds of thousands of dollars. Families across the country have experienced this issue, but it is rarely discussed. Needless to say, excessive medical debt incurred because of this arbitrary “birthday rule” can add damaging stress to these families.
To support these parents and fix the birthday rule, the Empowering Parents’ Healthcare Choices Act introduced by Rep. Sharice Davids (D-KS), would give parents up to 60 days after the birth of their child to choose which insurance policy will cover their new baby. The bill also would give the Administration authority to instruct insurers on how and when to notify parents of their rights.
This bill would give new parents more control over their health care and would offer them peace of mind. The 60-day window would give them time to compare premium rates and plan benefits, including what deductibles are required from each plan.
Let’s let our parents focus on the birth of their child with peace of mind. They know they have health insurance, but if this bill passes, they will also know that they will have just a bit more time to decide which of the two health plans is a better fit for their new family.
Written by Elaine Dalpiaz, Vice President, Health Systems and Strategic Partnerships with special thanks to Megan Condon for her contribution to this blog.