Newborn denied insurance coverage due to Preexisting Condition.

United States
March 28, 2010 10:35pm CST
http://www.youtube.com/watch?v=zRTcCotCULY How can it be preexisting, if he was just born?
4 responses
@FrugalMommy (1447)
• United States
12 Apr 10
Somehow, the fact that the insurance company that's denying coverage for the child is Blue Cross Blue Shield of Texas doesn't surprise me. My employer began offering coverage through them in January. Our plan year is the same as the fiscal year, so everything was supposed to have transferred over from the previous insurer. It didn't. I met my in-network deductible back in October, but they didn't carry that straight across. They chose to apply certain claims to my in-network deductible, and put the rest on my out-of-network deductible. I've been going back and forth with them and my benefits supervisor for almost four months now trying to get this garbage straightened out. It was supposed to have been taken care of back in February, but I just got a couple of statements showing that claims that were processed for my daughter's birth were applied to my in-network deductible. It's been so much of a hassle for me to deal with. I can't imagine the time that family's having with their application. I'm really glad my daughter's covered under my husband's insurance plan and not mine.
1 person likes this
@Aussies2007 (5339)
• Australia
29 Mar 10
If the parents were aware that the child would have the condition, but still went ahead in having it, it becomes their responsability. Why would an insurance, or the health care system for that matter, pay the medical bills because parents choose to be irresponsible? You cannot simply have children, and expect the system to pay the bills.
@laglen (19782)
• United States
29 Mar 10
wow! Cold but right. Pull no punches, lay it on the line. I bet the bleeding hearts hate you!
• United States
29 Mar 10
So, then, both Aussies2007 and laglen are pro-choice? I'm just keeping my scorecard up to date because Aussie's comment only makes sense if one believes that abortion should be safe and legal.
• Australia
29 Mar 10
Abortion is already safe and legal in civilise countries.
@Rollo1 (16689)
• Boston, Massachusetts
29 Mar 10
This is, at once, both a happy story and a sad one. The happy part is that this baby's condition was quickly diagnosed and surgically corrected. He will live. The sad part is that the parents cannot get his surgery covered by insurance. I honestly don't know if they can get insurance for him from the surgery onwards, that isn't mentioned, only that the surgery isn't covered. The condition can be pre-existing because he was alive before birth, just alive inside his mother's womb. This condition was present at birth, not one that occurred after birth. The problem is not that the insurance company would deny all babies born with this pre-existing condition. If the parents carried a policy, then they could add a new child to their policy within 31 days without any eligibility screening. Yhis condition and his surgery would then have been covered in full. But, they don't have a policy for themselves, or for the mother. The denial is based on the conditions of the new policy they wanted to initiate AFTER the surgery on a NEW policyholder, not an addition to an existing policy. It's a difficult reality for the parents, but it's a contract. They needed to know what their policy covers and doesn't cover. The good news is that they will probably qualify for a reduced fee for services, as most hospitals offer the uninsured and those with financial hardships. There is no insurance company that will sell you a policy to cover the surgery you had a week ago. But isn't it interesting that the insurance company just declared the unborn Houston a "person" and "existing" despite the common assumption that an unborn child isn't really alive?
• United States
29 Mar 10
What do you think the fee reduction will be, really? 10% off a $50,000 or more surgery? I can't say for sure what this couple was thinking, if they intended to insure him upon birth, or whatever, but it seems that way. When they went for their sonograms, etc, everything showed a healthy fetus. This congenital defect is rarely detected before birth. I don't know how they can declare the fetus as alive. If it were stillborn, and they wanted to deny coverage, they would probably term it a "fetus." I think they are just slimeballs in general.
@Rollo1 (16689)
• Boston, Massachusetts
29 Mar 10
Read the back of any hospital bill. It will tell you how to apply for free care or reduced care fees. I don't know what sort of financial arrangements they would be able to make. They own a small business so they purchase their own insurance. They gambled by not having insurance for themselves. What if the mother had experienced a life-threatening condition during labor or childbirth? They knew they'd have to pay for that out-of-pocket as they did for the pre-natal care and delivery expenses. I think it's going to present some financial hardships for them, but insurance is a business. If my house burned down on Tuesday, I couldn't expect to buy a fire insurance policy on Wednesday. If you seek to buy protection after the fact, it isn't insurance at all. They would declare the fetus in the womb alive based on the fact that he has his own blood type, a heartbeat, a complete central nervous system including his own brain waves, defecates and urinates and even practices respiration in the womb. We pull the plug when someone has no detectable brain activity, but babies have their own brainwaves at 20 weeks gestation. It's an odd dichotomy, I think.
@Sir_bobby88 (8245)
• Singapore
29 Mar 10
This is so sad , but what to do . Maybe we should not buy insurance at all after all.
• United States
29 Mar 10
The insurance company will play their stalling game until the law's time frame's gap has passed. Right now, under Obamacare, within 90 days, those with preexisting conditions can enter a high risk pool for health coverage, but, in the meanwhile, the insurance companies will play their games while they pray these lawsuits filed by some states will prove the bill to be unconstitutional. Money hungry people, at the expense at anyone.