Business ProfileforChildren's Health System of Texas

If you have a days-old newborn (using your insurance) taken to this hospital, be aware that you might be slapped with the full bill and insist your newborn does not have insurance. They will have financial counseling talk to you and will INSIST you self pay even if you have insurance. They will not bill the mothers insurance instead expect a 2 day old newborn to magically have his/her own insurance. They will most likely not listen to you even if you beg them to verify the insurance and explain that your newborn does not even have a birth certificate yet. My newborn was taken to this hospital at 2 days old and we were slapped with a 10,000 bill way over our individual deductible and out of pocket. This hospital despite the calling themselves a CHILDREN's hospital does not know anything about billing newborns. It was only after CALLING THEM AGAIN and AGAIN did they figure out that they were supposed to bill the mother instead of the newborn. They had no idea that the process for insurance claims with newborns is to claim under the mother. When they realized their mistake, their excuse was that my phone was not a working number and couldn't verify. When they do NOT need to call me to verify the DATE OF BIRTH of the baby when it is all over his medical records! Their billing/insurance/financial services department needs training and better customer service. That British sounding person I spoke with at financial services needs to educate the rest of the staff in this office. I was lucky to have finally reached someone not as incompetent as the rest of the staff.

Thank you for sharing your experience with us and allowing us to review your case. While many plans offer newborn coverage for the first 31 days, some plans (i.e., this one) does not. When we are unable to verify coverage for a patient, our Financial Counseling team works with the family to explore all payment options including government programs (i.e., CHIP, Medicaid, etc.), financial assistance, self-pay discounts, interest-free payment plans, etc.

When we verified the patient's benefits on 1/17/22, we were told that this plan does not automatically cover newborns for the first 31 days. Since the patient's eligibility could not be verified, the account remained in Self-pay status, with regular follow-up calls to the Guarantor. When we spoke with the Guarantor on 2/15/22, she advised that she was still waiting for the patient's birth certificate which she anticipated receiving in a couple of weeks. We requested for the Guarantor to notify us when the enrollment process was complete.

On 3/1/22, the Guarantor called to provide an update on the patient's enrollment, and we added the BCBS coverage and initiated the claims process. On 3/3/22, we received a call from BCBS advising that the Guarantor had contacted them regarding the bill she received from us. We explained that the bill was from February and advised that we spoke with the Guarantor two days earlier, assuring her that the coverage had been added to initiate the claims process.

We received the BCBS payment on 3/11/22. Per the Explanation of Benefits (EOB), the member owed $2601.86 ($1452.38 Deductible + $1149.48 co-insurance). We received a payment of $1927.47 on 3/18/22, leaving a current self-pay balance due of $674.39.

Sincerely,

Paula P*****, Manager
Patient Financial Services
Children's Health

Clearly, our insurance covered the visit and your financial counseling department had no business INSISTING that we self pay. An apology from your office for insisting that we self pay instead of waiting for the verification would have been nice. Please educate your staff to wait until the verification instead of INSISTING that a guarantor self pay or bill under the mother (me) instead of the newborn. We received newborn care outside of your facility and we were never harassed by a financial counseling department like yours did.

Thank you for your feedback. Please accept my apology for your experience. This clearly did not meet the service levels we strive to provide to our families. In light of this, I've added a one-time Administrative Adjustment for your remaining balance of $674.39.