My wife has health coverage (different from mine) through her employer. Her deductible is $1300. In May my daughter was born. Until then my wife incurred a lot of expenses and met the deductible.

When my daughter was born, we added her to my wife's plan. The deductible was increased to $2600. Which is fine, and understandable.

However, when the hospital bills for the labor came in the insurance is claiming that the applicable deductible should be $2600, since my daughter's insurance is effective from her birth date.

I disagree. Labor is a procedure that my wife went through. Specifically, if I had insured my daughter under my plan my wife's insurance would have had to pay for all of it since my wife was billed. The only things we would have had to pay would have been medical procedures specific to my daughter and through my plan.

I believe that they are on the hook for everything they would have had to pay and the deductible should come "online" only for things specific to my daughter or any post-partum medical visits of my wife.

Who is right? How do I argue this effectively?

  • 8
    I think the only way to answer this is to read your insurance policy that governs these things. – JohnFx Jul 29 '15 at 21:21
  • 1
    Would your plan deductible have increased if you had enrolled your daughter in your health plan? Often-times. family health plans have (or maybe had in the "good old pre-Obamacare days") a deductible for each individual separately and a global maximum deductible of 2 to 2.5 times the individual deductible so that when all the cheaper by the dozen kids got measles, there would not be 12 different deductibles applicable to payment of their treatments (meaning nothing gets paid by the insurance company), but rather most of the treatments would be covered. Moral: have plenty of children. – Dilip Sarwate Jul 29 '15 at 23:16
  • I believe my own employer considers this (along with getting married) one of the few justifications for changing your health care plan in mid-year. Of course you'd need to re-evaluate all the options for cost vs. deductable vs. coverage. – keshlam Aug 2 '15 at 3:17
  • Is your plan an H.S.A compatible HDHP? While most non HDHP have separate deductibles per person ("embedded deductibles"), a family HDHP plan cannot offer an individual deductible lower than the minimum family deductible for HDHP. For this reason most HDHP plans use what is known as an "aggregate deductible" (one big deductible for the whole family put together). – lzam Dec 21 '17 at 20:58

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