LAS VEGAS (KTNV) — Jaxson Khalilzadegan can’t find the words to describe what it’s like having adult-sized debt while he’s still in diapers.
Having a baby’s expensive, sure, but Jaxson’s big day came with a bigger bill than mom and dad expected.
"It put a bitter taste on a very sweet moment," said Steven Khalilzadegan, Jaxson's dad.
After being delivered via C-section at Spring Valley Hospital, Jaxson spent a few precautionary days in the neonatal intensive care unit, which Steven and Savannah believe was unnecessary.
But they thought Savannah’s insurance policy with Health Plan of Nevada would cover whatever services they got under her $6,600 deductible.
"I called the insurance company, said we’re having a child, is this what it’s going to cost?" Steven recalled. "They said yes, $6,600. One deductible for the mother and that will cover your expenses. And we were happy about that and that’s what we expected and planned for when we got into it."
HPN’s agreement of coverage states, “The subscriber’s newborn natural child is covered for the first 31 days from birth," which Steven says he re-confirmed when Jaxson was in the NICU.
"Is there anything we should know? Is it just the one deductible and he’s covered for 30 days under the mother’s plan?" Steven recalled. "And they said 'yes, that’s exactly what it is.'"
Not exactly, as it turns out.
"After we checked out and of course they processed the bills, we ended up with two deductibles: $6,600 for Jax and $6,600 for Savannah."
"He was charged to be born?" Darcy Spears asked.
"The day he came out of the womb they said, 'Here you go, Jax, you’re on the policy, $6,600.'"
This, after Savannah had almost met her own deductible.
Darcy: "You’re planning for a few hundred dollars out of pocket at this time."
Savannah: "Yeah. I don’t know... It’s kind of a mind-blow."
Steven says when they added Jaxson to the family plan, a series of glitches with the Nevada Health Exchange backdated the baby’s policy to the day he was born instead of kicking in a month later when his coverage under Savannah’s policy would’ve expired.
Should be an easy fix, but instead, Steven says they hit "a lot of walls and a lot of red tape. We’ve tried to take all of the necessary steps. We asked for an internal investigation from Health Plan of Nevada."
When that didn’t resolve anything, they filed a formal complaint for review with the Nevada Division of Insurance.
"They gave me back a letter saying we talked with Health Plan of Nevada, they already did an internal investigation and they said everything’s fine."
But Steven says everything is not fine at all, including the oversight he expected to protect the consumer.
"When we go to the government who’s supposed to be watching over our insurance companies, they rely on the insurance companies to police themselves."
State records show HPN told the insurance division “Newborn babies have their own cost share amounts (co-pay, calendar year deductible) when their claims are received/processed.”
Steven was told they could appeal, but only once. And since they’d already unsuccessfully challenged the NICU charges, they were out of options.
"Being the little guy against the large corporation, it’s not very fair."
That’s where 13 Investigates comes in.
We asked the Nevada Division of Insurance why the family had to pay twice for Jaxson’s birth. In a statement, they said, in part “... This does not appear to be an instance of the baby being billed for its birth, but rather for medical services required after the birth.”
It still seemed like fuzzy math to Steven.
"He’s covered for the first 31 days under the mother’s plan."
We tried to question Spring Valley Hospital about that, but they wouldn’t talk, saying federal privacy laws prevent them from discussing specific billing or patient issues.
When we said we had a HIPAA waiver signed by the family, they said that didn’t change anything.
But something did change with Health Plan of Nevada after we reached out to them.
Communications Director Lisa Contreras declined an on-camera interview but said, “While the claim was processed appropriately under the mother’s and newborn’s benefits, we are waiving the deductible for this newborn’s NICU hospital stay.”
With that $6,600 weight lifted, the family is free to enjoy the days leading up to their son’s first birthday and the ability to celebrate debt-free.
FULL STATEMENT FROM NEVADA DIVISION OF INSURANCE:
The Division reviewed this complaint once again and although the Division does not have all the medical records, based upon the bills that were involved, this does not appear to be an instance of the baby being billed for its birth, but rather for medical services required after the birth.
Under the Affordable Care Act (ACA), the newborn automatically gets put on the mother’s insurance plan for 31 days. What this means is that new parents do not have to contact their insurer immediately after giving birth. To continue the child’s insurance, they must request coverage within those 31 days, and pay the premium within 60 days, or the child’s coverage will be terminated.
This does not mean that the child’s expenses are paid under the mother’s deductible for 31 days. It means the child gets added as an insured under the mother’s plan. Normally, delivery is billed to the mother and therefore only has to meet her deductible. Additional medical services, however, are billed to which patient receives them, and each insured has to pay their own deductible (including the newborn). When a baby is born, the baby becomes an additional insured under the mother's health insurance policy.
In this case, it appears that both mother and newborn received medical services in addition to delivery, and were billed accordingly.
