Dependent-Child Billing & the Birthday Rule

Posted on 09. Apr, 2009 by Editor in Toolkit

Our easy key tells you when the birthday rule does — and doesn’t — apply.

If you bill for services to children, you’ve run across kids who are covered by more than one plan. You often have to decide which parent’s insurance plan covers a child.

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Take a look at this handy cheat sheet to ensure you pick the correct one every time.

Dependent Child Whose Parents Are Not Separated or Divorced, or Dependent Child of Parents With Joint Custody

You will typically follow the “birthday rule” in these cases. The birthday rule says that for a dependent child of parents who are not legally separated or divorced, the insurance of the parent whose birthday falls earlier in the year is the primary carrier, says Deb Flanagan, recovery unit manager for Inland Cardiology Associates in Spokane, Wash.

Tip: If both parents have the same birthday, the plan that has provided coverage longest is the primary carrier.

Remember: “Birthday” in the birthday rule refers to the month and day in a calendar year, not the year in which the parent was born, Flanagan says. “So, if one parent’s date of birth is April 28, 1961, and another’s is Jan. 28, 1970, the plan of the parent whose birthday is in January is primary even though they are years younger,” says Susan E. Garrison, CHC, PCS, FCS, CCS-P, CPAR, CPC, CPC-H, executive vice president, healthcare consulting services for Magnus Confidential in Dawsonville, Ga.

Caution: Some plans may instead go by the “gender rule” for dependent children. This rule states that the father’s coverage is the primary carrier. Creating a spreadsheet...

Tags: birthday rule, dependent-child billing, front desk, gender rule, insurance