Author Topic: Billing for admission and discharge of new born babies at a hospital?  (Read 1008 times)

DaveMoody

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There are some private practice physicians who see newborn babies at a hospital as the newborn's admitting doctor. Then the Doctor submits a claim to the newborn's insurance company for admission and discharge of the newborn by using their private practice as the billing provider and the hospital where they saw the baby at as the service facility.

So now my question is, what if the baby ends up not being covered under the mother's insurance, can you use the mothers information while submitting the claim to the insurance for the admission and discharge service for the newborn?

Or how else does this work if you find out the baby isn't covered under the mother's insurance?

kristin

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I am going to try and answer your question, using info I found on the internet, since I don't do this kind of billing. Hopefully someone here who does do this kind of billing will jump in also, and verify if what I found is correct.
Once the baby is born, they are considered an individual, and as such, need to either be added to the mother or father's insurance, OR they need to be insured under their own policy. My understanding is you cannot bill services rendered to the baby under the mother's info, as though she was the patient, because the baby is now an individual.

Michele

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Kristin is correct.  Once baby is born they are their own person and have to have their own insurance.  If mom or dad has insurance that they will be covered under the insurance carrier usually sets up that plan immediately.  If the mom is covered under Medicaid usually (but this can vary by state) the baby is automatically eligible and covered under Medicaid from birth with their own policy.  Any services to the newborn must be billed under the newborn.

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PMRNC

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With my plan and many other's ..the newborn hospital charges are covered under the mothers file.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Michele

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With my plan and many other's ..the newborn hospital charges are covered under the mothers file.


The physician's fees for the newborn admission?  I thought those had to be under the newborn. 
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PMRNC

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Quote
The physician's fees for the newborn admission?  I thought those had to be under the newborn.

Yes some plans have up to 90 days to enroll a new dependent and no file has been created for the newborn.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com