NICU stay not covered by MetroPlus

Hello mamas, I’m so shocked to be typing this. Our beautiful girl born Jan 8th at NYU Langone Brooklyn has been denied coverage by our insurance for her NICU stay. Has anyone gone through this before, all advice welcome. We have MetroPlus as our insurance carrier but not through Medicaid we make just over the amount financially to qualify for Medicaid. The rep told us our daughter’s NICU stay would have been covered only if our plan was through Medicaid but because it is a commercial plan through New York State of health the Benefit is denied this applies to all tiers of their plans. I’m just shocked, and hoping for guidance advice? Is it worth appealing and if yes has anyone had success with this?

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I would appeal it. It’s worth trying.

And try to change coverage if you can, asap! Fidelis is really good. Healthfirst maybe? It may be past the deadline now but that’s just so unfortunate. I hope your little one is doing well 💗

I know nothing about this personally unfortunately but I would definitely appeal and look into free legal aid and help from a social worker from the hospital. This is beyond unacceptable I’m so sorry.

Does baby not qualify for Medicaid herself? When my kids were born I didn’t qualify for Medicaid, however during my pregnancy I had reached out to NYS of health and they gave each of my kids Medicaid same day.

Also I’d recommend Fidelis! They’ve given me no issues.

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