Wiki Hospital Bill after one year

[ShannonSGolden]

A young lady, 25, is under dad’s insurance as a dependent
She had a baby 7/26/23
Baby had a head scan 8/22/25
One year and one month later later mom received a bill for $2660 from facility where scan was performed with an adjustment from the insurance (dated 8/28/24) leaving her with a $931 charge
The insurance company notified her that her dad never added the baby to the plan which they did not realize until calling regarding this situation. Insurance said even if he was retro added, the timely filing limit is passed and it would not be covered
The facility that did the scan says they need to pay it.
Is this correct?

 

[sls314]

A young lady, 25, is under dad’s insurance as a dependent
She had a baby 7/26/23
Baby had a head scan 8/22/25
One year and one month later later mom received a bill for $2660 from facility where scan was performed with an adjustment from the insurance (dated 8/28/24) leaving her with a $931 charge
The insurance company notified her that her dad never added the baby to the plan which they did not realize until calling regarding this situation. Insurance said even if he was retro added, the timely filing limit is passed and it would not be covered
The facility that did the scan says they need to pay it.
Is this correct?

If the patient did not provide correct insurance information to the provider, then yes the patient can be billed.

Are you saying that the mom thought the baby was added to the policy that mom is a dependent on? (Mom's dad/baby's grandpa's policy?)

Typically a dependent of a dependent cannot be added to a policy. It would have been highly unusual for Grandpa's group plan to allow the baby to be added. (Unless grandpa was the legal guardian, perhaps.)

Did the baby have any insurance?

Was the baby receiving regular well-child checkups? What insurance has been billed for those? It makes sense to me that the baby didn't have coverage on grandpa's policy, but I would assume mom had added the baby to some other policy. Medicaid, perhaps?

 

[amyjph]

A young lady, 25, is under dad’s insurance as a dependent
She had a baby 7/26/23
Baby had a head scan 8/22/25
One year and one month later later mom received a bill for $2660 from facility where scan was performed with an adjustment from the insurance (dated 8/28/24) leaving her with a $931 charge
The insurance company notified her that her dad never added the baby to the plan which they did not realize until calling regarding this situation. Insurance said even if he was retro added, the timely filing limit is passed and it would not be covered
The facility that did the scan says they need to pay it.
Is this correct?

Question - "Baby had a head scan 8/22/25" That is in the future... Did you mean 2024?
How old was the mother at the time of the scan? If the birth was 7/26/23 and she was 25 y/o, did she turn 26 in the meantime? Was the mother off the parent plan on 8/22/24?
Agree with Susan - baby would not be covered on the grandfather's health plan. Probably should have been Medicaid.

This situation requires more research.

 

[sls314]

Question - "Baby had a head scan 8/22/25" That is in the future... Did you mean 2024?
How old was the mother at the time of the scan? If the birth was 7/26/23 and she was 25 y/o, did she turn 26 in the meantime? Was the mother off the parent plan on 8/22/24?
Agree with Susan - baby would not be covered on the grandfather's health plan. Probably should have been Medicaid.

This situation requires more research.

Adding that I answered under the assumption that the head scan was in August 2023, since it was mentioned that mom received a bill one year and one month later.

However, if the service was actually in August 2024, that should help because it should be within the filing limit for most plans. (If the child does have insurance through some other source that the facility just didn't know about.)