Medical Billing Forum
Medical Billing Forum - Get all of your billing & coding questions answered here!
Welcome,
Guest
. Please
login
or
register
.
Did you miss your
activation email
?
1 Hour
1 Day
1 Week
1 Month
Forever
Login with username, password and session length
News:
Online Courses!
Start Taking Medical Billing Courses Online - Free Financing & Special Discounts Available!
Click Here for the Savings
Home
Help
Search
Login
Register
Medical Billing Forum
»
Payments
»
Insurance Payments
(Moderators:
Alice Scott
,
Michele
) »
Do maternity services coverage apply to newborns?
« previous
next »
Print
Pages: [
1
]
2
Author
Topic: Do maternity services coverage apply to newborns? (Read 13449 times)
carefornelly
Newbie
Posts: 5
Do maternity services coverage apply to newborns?
«
on:
July 12, 2017, 04:41:02 PM »
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.
«
Last Edit: July 12, 2017, 05:44:33 PM by carefornelly
»
Logged
PMRNC
Hero Member
Posts: 4562
Re: Do maternity services coverage apply to newborns?
«
Reply #1 on:
July 13, 2017, 10:48:04 AM »
Assuming your plan does cover inpatient maternity at 100%, did Cigna process the baby's charges under the mothers file? They should have. Check that first. If they didn't they need to reprocess the claim under the mothers file and then it should be 100%. It's possible Cigna had added your baby within the time frame the bill was submitted and Cigna processed under the newborn rather than under the mothers file. Look at your EOB to make sure. If they DID process under the mother's file, what is the exact reason for the "non covered" or "reduced" charges? And finally I'm assuming the hospital is in your network?
I'd also research any state laws regarding balance billing for your state.
Logged
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com
carefornelly
Newbie
Posts: 5
Re: Do maternity services coverage apply to newborns?
«
Reply #2 on:
July 13, 2017, 12:10:42 PM »
PMRNC, thank you for the reply.
1. The hospital is in the network. The hospital is in New Jersey.
2. Our plan covers Maternity Services at 100%, specifically:
Delivery Charges (i.e. global maternity fee)
Physician’s Office Visits in addition to the global maternity fee when performed by an OB/GYN or Specialist
Delivery - Facility (Inpatient Hospital, Birthing Center)
3. Newborn's claim was submitted after the mother's claim was processed and finalized. Newborn's claim is a separate from the mother's: had it's own reference number, the itemized bill from the hospital shows the newborn's Cigna id (BTW, how could they figure out the Cigna id if I gave it only to the pediatrician???).
What does mother's file mean? Sorry, I am not a billing specialist, just a customer, and not familiar with the terminology. How can I get the details regarding "non covered" or "reduced" charges?
Thank you for your answers.
Logged
PMRNC
Hero Member
Posts: 4562
Re: Do maternity services coverage apply to newborns?
«
Reply #3 on:
July 13, 2017, 12:25:37 PM »
Ok, your problem may be that they did not process the baby's charges under your file which they should have. Because of that the hospital billing was processed as a NON maternity claim and subject to the 10% coinsurance rate. Since you said the baby had an ID # that tells me they processed under the baby not you which is incorrect. I would call them up and explain that the newborn's facility charges should be processed under YOUR file and should NOT be subject to the 90% but rather 100%. Again, I'm assuming the baby and you were both in hospital at same time.
Logged
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com
carefornelly
Newbie
Posts: 5
Re: Do maternity services coverage apply to newborns?
«
Reply #4 on:
July 13, 2017, 07:14:02 PM »
Thank you for the answers.
The baby and the mother were in the hospital at the same time.
Whom should I ask to reprocess - the hospital or Cigna? It was the hospital, who sent the claim with the baby's Cigna id. So, it sounds logical to ask the hospital to send the corrected claim with the mother's id. Or Cigna is smart enough to link the 2 claims having the same dates of service, and service date is the same as baby's birth date?
Logged
Medical Billing Forum
Re: Do maternity services coverage apply to newborns?
«
Reply #4 on:
July 13, 2017, 07:14:02 PM »
PMRNC
Hero Member
Posts: 4562
Re: Do maternity services coverage apply to newborns?
«
Reply #5 on:
July 13, 2017, 08:16:55 PM »
Well, Cigna really should reprocess under the mother BUT I would not be surprised if they make you have the hospital send a corrected claim. I would probably START with calling Cigna and see which they suggest. If you do have to call Cigna, tell them they must submit a "CORRECTED CLAIM" and put it as newborn charges UNDER your ID. Incidentally usually dependents under a plan don't have ID#'s individually. The ID number is usually the plan holder's ID number.
Logged
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com
mainiaDup
Sr. Member
Posts: 260
Re: Do maternity services coverage apply to newborns?
«
Reply #6 on:
November 08, 2022, 04:03:00 PM »
Our findings suggest that it will be important to consider the method of assessing mammographic density <a href=http://priligy.me/>priligy cvs</a> This separate comparison group was included to facilitate assessments of changes associated with the NCCCP participation net of the effects of general trends on improved quality of care
Logged
priligy 60 mg
ZooxySeno
Jr. Member
Posts: 59
Re: Do maternity services coverage apply to newborns?
«
Reply #7 on:
November 14, 2022, 06:46:41 AM »
Waldo gGUjxVhvhWre 6 27 2022 <a href=http://nolvadex.one/>buy tamoxifen</a>
Logged
what is nolvadex
jossibe
Full Member
Posts: 247
Re: Do maternity services coverage apply to newborns?
«
Reply #8 on:
November 18, 2022, 11:43:09 PM »
<a href=https://stromectol.ink/>ivermectin rosacea</a> A molecular dissection of the signaling pathway revealed that Elk 1 activates 9E3 cCAF expression via two Elk 1 binding sites in the proximal promoter region 28
Logged
stromectol uk
unorgobug
Sr. Member
Posts: 330
Re: Do maternity services coverage apply to newborns?
«
Reply #9 on:
November 20, 2022, 05:52:32 AM »
<a href=https://doxycycline.world/>doxycycline for acne reviews</a> In the current study, we used the iCOGS array and genotype imputation to investigate whether variants in the TERT CLPTM1L candidate region are associated with the risk of endometrial cancer in populations of European descent
Logged
doxycycline nausea
Medical Billing Forum
Re: Do maternity services coverage apply to newborns?
«
Reply #9 on:
November 20, 2022, 05:52:32 AM »
royagma
Sr. Member
Posts: 326
Re: Do maternity services coverage apply to newborns?
«
Reply #10 on:
November 23, 2022, 10:11:27 AM »
When in doubt, you should do two drying cycles and split your clothes in two <a href=https://lasix.autos/>order lasix over the counter</a>
Logged
taking lasix but still swelling
Vogegrorb
Sr. Member
Posts: 334
Re: Do maternity services coverage apply to newborns?
«
Reply #11 on:
December 11, 2022, 04:22:57 AM »
<a href=http://ccialiss.icu>cialis online without</a> These elevations of Ca 2 i were absent in a Ca 2 free medium
Logged
para que sirve levitra 20 mg
lapound
Sr. Member
Posts: 340
Re: Do maternity services coverage apply to newborns?
«
Reply #12 on:
December 14, 2022, 04:07:51 PM »
NKF Government Relations is working to bring the patient s voice to the Administration s response to the threat of COVID 19 <a href=http://propecias.buzz>finasteride</a> As expected, the combination of AZD5991 and Venetoclax showed synergy and fully rescued mutant cell lines from KRAS and PTPN11 mediated resistance
Logged
propecia hairline
piegmen
Sr. Member
Posts: 326
Re: Do maternity services coverage apply to newborns?
«
Reply #13 on:
December 16, 2022, 01:39:53 AM »
<a href=https://lasix.one>lasix pill identifier</a> While higher doses of paroxetine mesylate and paroxetine hydrochloride are available, they are reserved for the treatment of depression and other psychiatric disorders
Logged
buy priligy generic
Faispom
Sr. Member
Posts: 322
Re: Do maternity services coverage apply to newborns?
«
Reply #14 on:
January 29, 2023, 07:07:15 AM »
This steroid is offering the huge benefit of reducing the amount of SHBG by very strongly binding to it <a href=https://cialis.autos>can you buy cialis online</a> Lucio, USA 2022 06 18 10 02 01
Logged
buy cialis pro
Medical Billing Forum
Re: Do maternity services coverage apply to newborns?
«
Reply #14 on:
January 29, 2023, 07:07:15 AM »
Print
Pages: [
1
]
2
« previous
next »
Medical Billing Forum
»
Payments
»
Insurance Payments
(Moderators:
Alice Scott
,
Michele
) »
Do maternity services coverage apply to newborns?