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Coverage Change During Inpatient Stay


Guest ronc
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Can anyone tell me what should happen when a patient has an insurance coverage change during the time he/she is admitted to the hospital? Does the coverage in effect at the time of admittance cover until the patient is discharged? Or should coverage change on the effective date of the change? What about if there is a change in the insurance company?

It would seem logical that the coverage and company should stay in effect until discharge. Seems I recall policies stating that employees or dependents who are hospitalized at the time the policy, or policy change, becomes effective, are not covered until discharged.

Now for the kicker. Is this covered by State regs, federal regs or other? A cite would be helpful?

tks

Ronc

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  • 14 years later...

I realize this is an old question. 

This is covered in Title 42 Section 422.264 of the Code of Federal Regulations as far as CMS (Medicare) goes.  https://www.gpo.gov/fdsys/pkg/CFR-2001-title42-vol2/pdf/CFR-2001-title42-vol2-sec422-264.pdf  see pages 846-847. The insurance at the time of admission would be responsible through the inpatient stay. 

I'm not sure whether commercial payers play by the same rules. 

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