February 13, 2021

Ever heard of the “Birthday Rule” when it comes to health insurance? Neither had this family | Investigations

OLATHE, KS (KCTV) — Charlie Kjelshus is two-years old. She obsessed with Disney’s “Frozen” and…

OLATHE, KS (KCTV) — Charlie Kjelshus is two-years old. She obsessed with Disney’s “Frozen” and bounce houses. She’s engaging in adorable conversations about the passions in her world.

You’d never suspect she had a rough start in life.

“When they cut the umbilical cord, she had an Apgar score of 2,” said her dad Mikkel Kjelshus.

Doctors suspect Charlie was deprived of oxygen during her birth. Her parents were encouraged to transfer her to a hospital with a full NICU, Overland Park Regional Hospital.

Charlie’s expensive test and treatments included whole bodying cooling. It worked. Charlie was released within a week with excellent news.

“She didn’t have any injuries the MRI looked normal and that was when we could finally breathe that huge sigh of relief that things were going to be okay,” her mom Kayla Kjelshus said.

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“Birthday Rule”

Then the bills came… those topped more than $270,000.

At first, Blue Cross and Blue Shield paid the bills but then retracted payments before they went through. The family was stunned. They had carefully selected Kayla’s health insurance plan for their daughter to join. It was much better that her father’s policy.

A benefits investigator realized Mikkel’s policy could also be used and an insurance regulation known as the “birthday rule” could apply.

“They investigated I had a job and through my job I had insurance and my birthday was actually before my wife’s,” Mikkel Kjelshus said.

If both parents each have a policy, then insurance companies are supposed to investigate who has the early birthday. Not by year, but by date on the calendar. The birthday rule was established by the National Association of Insurance Commissioners. It’s followed by almost every state including Kansas and Missouri.

“This was to give some uniformity to the rules so people would be treated fairly,” health insurance expert Carey Hall explained.

The Kjelshus family has a different view…

Family gets turned over to collections

The family describes a nightmare process. It included hospital bills being resubmitted to an out of state, out of network insurance company they had not selected for their daughter. Communication between the dad’s primary and mom’s secondary insurance and the hospital was rough at best.

The family was turned into collections as they fought the much higher charges. Some resubmitted bills were considered too old to pay by the new primary carrier.

The Kansas Insurance Commission was of little help to the family. The family points the dad’s name was misspelled in an important letter from BCBS.

Eventually- many of the charges were resolved but the family still doesn’t understand how all the deals were cut. It’s important to note the mother is a nurse practitioner and understands health insurance better than the average consumer.

The family questions the lack of choice and the birthday rule regulation.

“To say ‘okay because your husband’s birthday is two weeks before yours, he’s the primary!’ So, even though you are paying us premiums, we aren’t going to be your daughter’s insurance. It just doesn’t make sense. I think it’s a decision that should be left up to families,” Kayla Kjelshus said.

The family also suspects the birthday rule is arbitrarily applied in expensive cases pointing out BCBS originally paid then changed course.

They are also baffled BCBS decided to review two previously revolved charges.

Charlie is turning 2 years-old and the bill is so old, even the doctor has retired.

The parents just shake their head and say health insurance shouldn’t work this way.

“It’s just a frustrating process. And I hope there’s a way for other individuals to figure out if they would be in a bind, Kayla Kjelshus said. “The only way to have done things different is for my husband to drop insurance and be uninsured.”

Insurance Advice

We turned to a health insurance expert for advice.

Cary Hall says insurance plans can be difficult to navigate. Sitting down with your company’s benefit coordinator can often help you understand your policy better.

Hall says carefully reviewing policies at major life events like the birth or adoption of a child is a smart idea.

He says one potential work around to the “birthday rule” would be for families to join one preferable policy so a newborn would only have one available policy.

The other option of leaving a parent uninsured would also technically work but would obviously leave that parent without medical coverage and that could lead to outrageous medical debt.

We reached out to HCA, the owners of Overland Park Regional Medical Center. They provided this statement:

As part of the standard patient admission process, Overland Park Regional Medical Center provides financial counselors to guide patients and their family on insurance coverage, benefits and available financial resources. This process includes confirming with the patient or their family their insurance policy, hospital benefits, co-payments, etc. 

In this case, the hospital was not initially aware that the patient had two insurance plans.  Once this information was made available,we filed with each insurance carrier, as hospitals are required. It is up to those carriers to coordinate coverage and reimbursement.  This process resulted in a longer period of time than anticipated.

In the meantime, we made an administrative error and an automated billing call system for payment occurred, causing the family undue frustration during an already stressful time, and we apologize.

Once the issue was identified and resolved, the insurance companiesprocessed the claim and we informed the family that there is a zero balance on the account.  Again, we are sorry for the stress and inconvenience, and wish them well.

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