Expecting? The 'birthday rule' could determine if you or your partner's insurance company pays

Denise Dador Image
Thursday, February 9, 2023
The 'birthday rule' could determine who pays for your child's birth
The rule states that the insurance plan of the parent whose birthday comes up first in a calendar year is responsible for paying for the child's birth.

HIGHLAND PARK, Calif. (KABC) -- If you and your partner are starting a family, and both of you have different health insurance plans, beware.

There is a little known "birthday rule" that decides who pays for a baby's delivery and first month of life.

One Highland Park couple was blindsided and ended up owing thousands of dollars all because one of their birth dates came before the other.

Bowie Tinio, who's a strong and healthy 20-month-old now, was severely anemic at birth.

"He was probably losing blood in the womb," said Bowie's father, Mike Tinio.

"It was a complicated delivery. He actually ended up in the NICU for four days," said Vanessa Ying, Bowie's mother.

Four days in the neonatal intensive care unit costed them $80,000. Before getting admitted, Ying was told the first 30 days of a baby's life are covered under the mom's policy so she increased her insurance benefits in case of an emergency.

"She made sure she got the best insurance that she could get, " Tinio said.

Then two months later, the couple started getting medical bills amounting to more than $10,000.

"I was really confused. I thought we had paid all our hospital bills so I didn't know why we were getting some additional bills," Ying said.

After countless calls, Ying found out her insurance company denied coverage and was going after her husband's plan because of the little-known "birthday rule." It's an insurance practice used to determine which plan a newborn falls under when both parents have insurance.

"It's not made to make life better for consumers," said Professor Glenn Melnick with USC's Sol Price School of Public Policy.

The rule states that the insurance plan of the parent whose birthday comes up first in a calendar year is responsible.

"So if my birthday is in January and my wife's in February, then the children get assigned to my policy in January because my birthday comes up first in the year. There's this hidden trap that can end up costing them thousands if not tens of thousands of dollars," Melnick said.

In Tinio and Ying's case, it was a difference of about $7,000. Melnick said new parents with dual coverage need to do their homework.

"You're not getting double coverage because of the birthday rule and so you should figure out which policy is the best one," he said.

An advocate in Ying's human resources office stepped in. After 20 months, Ying's insurance company agreed to pay and the collection calls stopped. Despite proposed legislation to do away with this birthday rule, it's still widely practiced.

"If at all possible, just be on the same insurance plan."

For now, their growing family is sticking with one health plan.

Tinio and Ying are expecting another baby and this time, they're ready.