We recently welcomed our baby daughter after a C-section delivery. We have Cigna Open Access Plus, which covers Maternity Services at 100%, including in-hospital stay during delivery.
The hospital submitted a claim for the mother, which was initially paid by Cigna at 90%. I called Cigna, and asked to reprocess. They did, and sent the remaining 10% payment to the hospital.
Few weeks later the hospital submitted a claim for the newborn. Cigna, again, paid only 90%. I called Cigna, hoping that they did the same mistake. They said that the hospital billed it as a regular hospital stay, which is covered at 90%.
I asked the hospital to send me the itemized bill. The biggest expense was Nursery (which we never used, BTW). It was charged under Revenue code 171, which is "Nursery, Newborn, Level I".
Another call to Cigna. This time I mentioned this revenue code, asking to treat the newborn stay under Maternity Services. I was told that the newborn is not the mother, that's why her stay was paid as the regular hospital stay.
How can I make Cigna to pay in full? The federal laws states the duration of stay after the C-section, and that the benefits can't be denied. The newborn claim was not denied, but was not processed the way we wanted.