The Newborns’ and Mothers’ Health Protection Act (NMHPA) is a federal law that guarantees that a woman and her newborn baby will be allowed to stay in the hospital for at least 48 hours after a vaginal delivery or 96 hours after a C-section delivery. The act prohibits group health insurance plans from providing any incentives or disincentives to the mother or the hospital that might encourage a shorter stay.
When Does the 48-hour or 96-hour Period Start?
The 48-hour or 96-hour period starts at the time of delivery. If you deliver outside the hospital and are admitted to the hospital for treatment related to the childbirth, then the period starts the time you are admitted to the hospital.
Am I Protected under the Newborns’ and Mothers’ Health Protection Act?
Whether or not you are protected under the Newborns’ and Mothers’ Health Protection depends on two key factors.
First, it depends on whether your group health plan cover hospital stays in connection with childbirth. The NMHPA does not require health plans to cover your hospital stay, although Title VII of the Civil Rights Act of 1964 may impose such requirements.
Second, even if your insurance covers hospital stays in connection with childbirth, whether or not you are protected under the NMHPA depends on how your group health plan provides benefits. If your benefits are paid by an insurance company or an HMO, your group health plan is an insured plan. If your benefits are paid by your employer or union, your group health plan is a self-insured plan. Your plan administrator can tell you if your coverage is insured or self-insured. If your coverage is self-insured, then you are protected under the NMHPA.
If you are in an insured group plan or if you have individual insurance coverage, the NMHPA might not apply if your state has a law with certain requirements for hospital stays after childbirth. If so, the state law takes precedent over the NMHPA. The state law may differ slightly from the NMHPA, so it is important for you to know which law applies to your coverage in order to know what your rights are.
Can My Health Plan or Insurance Provider Charge Me For the Hospital Stay?
A group health plan, insurance company, or HMO can impose deductibles for your hospital stay. However, they cannot require you to pay more for the latter half of your 48- or 96-hour stay. This would be a form of incentive or disincentive that is prohibited under the NMHPA.
Can I Decide to Leave on My Own?
A mother can independently decide to leave the hospital before the 48-hour or 96-hour period if she and the doctor (or nurse midwife) agree that the stay has been sufficient, as long as there was no pressure from the insurance company to cut the hospital stay short.
Do I Need a Lawyer Specializing in Health Insurance?
Interpreting the NMHPA and related state laws can be complicated. An experienced insurance attorney can help you understand your rights under the NMHPA laws. If you believe your health insurance company is acting in bad faith and improperly denying you coverage, an attorney will know all the ins-and-outs of taking on a big health insurance company.