Obscure ‘Birthday Rule’ Costs Colorado Couple $5,000 More For Normal Hospital Birth

By Kati Weis

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    WESTMINSTER, Colorado (KCNC) — A little-known Colorado insurance law is making a big difference for a Westminster couple, and they’re hoping their story will alert other expecting parents. Jessica Rapp and Jake Irwin say they are having to pay $5,000 more for the birth of their son, Jack, simply because of when their birthdays fall in the calendar year.

Rapp says Jack was born last August without any complications, and the hospital stay for the birth was only two nights. But three months later, she learned those two nights would cost her family $5,000 more, due to a law called the “birthday rule.”

The rule says if each parent has separate insurance, the newborn must be covered under the parent whose birthday falls earlier in the calendar year.

Irwin’s birthday is in January, and Rapp’s birthday is a month later in February, so Jack had to be covered under his father. But Irwin’s insurance isn’t as good as his wife’s, so the family is now looking at a three-year payment plan just to pay off the birth.

“Completely arbitrary,” Irwin said. “If we have one insurance, that seems to be fine, but the fact that we have two insurances and are almost at fault for that we’re being charged more doesn’t make sense.”

They’ve spent hours over the last few months trying to figure a way out.

“We had never heard about it before,” Rapp told CBS4. “It was never mentioned at any prenatal appointments with my doctor, or my phone calls with the insurance company beforehand, or my employer benefits representative; I don’t know whose job it should be to tell people about this, but I feel like it needs to be passed on somehow.”

The Colorado Department of Regulatory Agencies Division of Insurance says the rule started in the 70s as a way to ensure a newborn would be covered.

“When it came about, it probably envisioned that the two parents with their employer-based insurance plans, probably would have very similar plans,” explained Vincent Plymell, Assistant Commissioner for the division. “Obviously we know that’s not the case, it’s very common for people – even similarly situated people – to have very different plans, often even within the same company. So, I could see where there could be some sort of feeling like a mismatch between the two parents employers plans.”

Plymell says there’s no way for expecting families to get around the rule for the initial birth, but parents can petition to change the insurance coverage for the baby within 30 days of the birth for any future medical expenses.

“One thing I would throw out to people is if they run into a problem regarding coverage – whether it’s related to the newborn or the birthday rule or not – if they feel that something’s amiss, something’s not right, to contact the Division of Insurance, even when rules are supposed to be followed and done in this way or that, mistakes are made,” Plymell said. “Sometimes it’s human error, sometimes it’s a system error, sometimes it’s a computer thing, and it’s worth asking the question; there is no cost to contact us and find out ‘hey what were things done correctly?’”

In the last two years, the division has only received five complaints about insurance coverage for newborns, and two of those were related specifically to the birthday rule.

Plymell says the rule is tough to change, because there needs to be a default to make sure a newborn has coverage.

“What’s the right rule? Is that a birthday rule, is it something else?” Plymell said. “You have to land on something, to ensure that newborn is covered.”

Rapp and Irwin hope legislators will take a second look.

“I truly think there should be a choice,” Rapp said. “I’m the one who had the baby, and I feel like as the mother, I should have a say in whether he is covered under my insurance plan or not… It just feels like as a new mom, to not be able to choose something so big about my baby seems like kind of like a right that I should have, that I don’t. So that’s been kind of frustrating and upsetting, and if the rule is going to stand, at least educate and make people aware of it beforehand, so they can prepare.”

Plymell tells CBS4 insurance companies are not required to give any separate notice prior to a birth about the birthday rule, rather, the notice is given in plan documents – like a summary of benefits document – when the insurance is acquired.

If you have questions or concerns about the birthday rule, or would like the Division of Insurance to investigate your situation, you can contact the division by calling 303-894-7490. You can also email the division at dora_insurance@state.co.us, or visit the division’s website.

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