NICU Bill Issues

Insurance Forum Health Insurance
1

I had a baby three months ago, and my child was monitored in the NICU for low blood sugar. About a month later, I noticed an Explanation of Benefits (EOB) on my account where every claim was processed except for the NICU bill, which came out to $100k. The insurance denied the claim with the code S1A, citing no coverage found. When I called the insurance company, they informed me that the ID on the claim was incorrect and that the claim needed to be resubmitted.

We contacted the provider and asked them to resubmit the claim. However, three months later, we received a letter from the provider stating that they cannot bill the baby’s account because the insurance has informed them that the baby hasn’t been added to the coverage. I plan to call the insurance company again tomorrow, but I’m confused since all other bills for the NICU, including the circumcision and doctor visits, were processed without issues. I’m having trouble understanding what the problem could be. Any advice or insights would be appreciated.

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2

After having my baby three months ago, we faced an unexpected challenge with the NICU bill. Despite the insurance covering all other claims, the $100k NICU charge was denied with a code S1A, citing “no coverage found.” When I reached out to the insurance company, they said the claim had an incorrect ID and needed resubmission. We asked the provider to resubmit, but months later, we received a letter saying they can’t bill the baby’s account because the insurance claims the baby isn’t added to the coverage. It’s frustrating since other NICU-related charges were covered, and I’m unsure why this one claim is stuck. I’ll be contacting the insurance again, but if anyone has insights on dealing with this type of issue, I’d really appreciate the advice!