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Thread: Family learns pre-existing conditions apply at birth

  1. #1
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    Default Family learns pre-existing conditions apply at birth

    Houston Tracy, a 12-day-old boy, has already survived a rare birth defect, a feeding tube and open heart surgery. Now his family is waiting to see how the battle with an insurance company will fare.

    Last week, Houston's parents found out that the term "pre-existing condition" can apply the moment someone is born.

    "When he came out, he made one little cry and he didn't really cry much," said Houston's father, Doug Tracy, 39, of Crowley, Texas.

    Tracy cut the umbilical cord and watched the hospital staff clean his son. But before his wife Kim Tracy, 36, could touch their son doctors got worried. "We could tell there was something wrong by the way they [the doctors] were acting," Doug Tracy said.

    Houston's skin wasn't turning a shade of pink like most newborns because, somehow, his blood wasn't getting enough oxygen. Doctors rushed Houston, with Tracy riding by his side, in an ambulance to Cook Children's Medical Center in Fort Worth, Texas.

    Within hours the Tracy family would learn their son was born with a heart condition called d-transposition of the great arteries, meaning the primary aorta and pulmonary arteries are transposed where they should meet the heart. Doctors wanted to operate within days to save his life.

    "In Houston's case he would not have survived had he not gotten the care," said Dr. Steve Muyskens, pediatric cardiologist at Cook Children's Medical Center, who treated Houston. "Most children with this [would] have a demise within days to months in life."

    Muyskens explained that with the aorta and pulmonary arteries switched the system creates two separate pools of blood -- a small amount that travels from the heart to the lungs and back to the heart and another pool of blood that travels from the body to the heart and back out without ever reaching the lungs for oxygen.

    "The red blood just circles on one side and blue blood circles on the other," Muyskens said. All of Houston's organs, including his heart, would soon die without red blood.

    Even if doctors could stabilize a child with Houston's heart condition they would only have a short window to operate.

    One Surgery Could Save a Life

    "The Gold standard is surgery -- arterial switch procedure," said Dr. Daphne Hsu, division chief of pediatric cardiology at Montefiore Medical Center in New York. "The procedure has to be done before the child is 1 month old, because then the heart starts to change and adjust to the circulation, and the pressure in the heart drops."

    Houston was born on Monday, March 15. By Friday that week, doctors operated successfully. Muyskens expects Houston will have a normal life, and likely won't even need medications.

    "Everybody's nickednamed him Rocky around there because he's a fighter," said Tracy.

    But by March 24, the Tracy family formally heard their son was denied health insurance.

    "We don't have health coverage on ourselves because it's too expensive these days and because of the economy," Doug Tracy said. The couple are small business owners and would have to buy individual policies, which they have for their other children Cooper, 4, and Jewel, 11.

    Doug Tracy said the family had no idea there was something wrong with Houston before he was born.

    "Prenatal, every doctor visit was perfect, his heart beat was fine," he said. But Tracy said he called Blue Cross and Blue Shield of Texas twice in preparation of Houston's birth, and he asked if they could get a policy on his son before he was born.

    "They said we can't do that because he wasn't born yet, but as soon as the baby's born go online and fill an application out," he said. Doug Tracy applied for Houston's insurance March 18, and the first month's premium of $267 was charged to his credit card, he said.

    "Wednesday, the 24, is when I got a letter of decline -- they declined it the day after the [health insurance] bill was signed," Doug Tracy said.

    Yet the provision in the health insurance reform act that prohibits health insurance companies from denying coverage to children with a pre-existing condition will only take effect six months after the bill was signed into law.

    Family Searches for Insurance Coverage

    Blue Cross and Blue Shield of Texas declined a phone interview with ABCNews.com about procedures to enroll newborns and their policies in light of the new health care reform act.

    But the company was willing to e-mail a prepared statement.

    "We share the public's concern for this child and for uninsured children across our state. As you may know, federal privacy laws prohibit me from releasing any information about members or potential members of Blue Cross and Blue Shield of Texas [BCBSTX]," Margaret Jarvis, senior manager of media and public relations at Blue Cross and Blue Shield of Texas, wrote in an e-mail.

    Jarvis said Blue Cross and Blue Shield of Texas would automatically cover newborns of parents who already had a policy with them for 31 days. After that time parents could opt to include their baby on their plan whether or not the child had health issues.

    "For children whose parents are not BCBSTX members, who want child-only coverage, we offer individual policies, beginning at the age of 60 days," wrote Jarvis. "BCBSTX has spoken with the father of this child, and we are exploring all available alternative coverage options."

    Doug Tracy said his family has found an alternative route to get his child coverage through the Texas Health Insurance Risk Pool, and the policy will only cost $277 a month -- $10 more than the premium on the policy he tried to take out for his son. However, he said he's confused since he will still have to apply through Blue Cross and Blue Shield of Texas if he goes through the Texas Health Insurance Risk Pool.

    "I don't hate them [Blue Cross and Blue Shield], they've done well for my other two kids," Doug Tracy said. "I just want them to do the right thing."http://abcnews.go.com/Health/HeartFailureNews/newborns-family-learns-pre-existing-conditions-apply-birth/story?id=10218514
    Gee, the insurance companies will do anything to avoid helping someone survive, even a tiny baby? I'm shocked.
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  2. #2
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    That's why getting rid of the insurance companies of pre-existing conditions is a big F-ing deal.

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    Elite Member witchcurlgirl's Avatar
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    Default Coverage Now for Sick Children? Check Fine Print

    WASHINGTON — Just days after President Obama signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.

    Mr. Obama, speaking at a health care rally in northern Virginia on March 19, said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”

    The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma, diabetes, birth defects, orthopedic problems, leukemia, cystic fibrosis and sickle cell disease. The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan.

    To insurance companies, the language of the law is not so clear.

    Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.

    William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”

    Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.

    “The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman, Democrat of California and chairman of the Energy and Commerce Committee.

    Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”

    The issue is one of many that federal officials are tackling as they prepare to carry out the law, with a huge stream of new rules, official guidance and brochures to educate the public. Their decisions will have major practical implications.

    Insurers say they often limit coverage of pre-existing conditions under policies sold in the individual insurance market. Thus, for example, an insurer might cover a family of four, including a child with a heart defect, but exclude treatment of that condition from the policy.

    The new law says that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010.

    But, insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a “guaranteed issue” requirement before then.

    Consumer advocates worry that instead of refusing to cover treatment for a specific pre-existing condition, an insurer might simply deny coverage for the child or the family.

    “If you have a sick kid, the individual insurance market will continue to be a scary place,” said Karen L. Pollitz, a research professor at the Health Policy Institute at Georgetown University.

    Experts at the National Association of Insurance Commissioners share that concern.

    “I would like to see the kids covered,” said Sandy Praeger, the insurance commissioner of Kansas. “But without guaranteed issue of insurance, I am not sure companies will be required to take children under 19.”

    A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.
    Starting in January 2014, health plans will be required to accept everyone who applies for coverage.

    Until then, people with pre-existing conditions could seek coverage in high-risk insurance pools run by states or by the secretary of health and human services. The new law provides $5 billion to help pay claims filed by people in those pools.

    Federal officials will need to write rules or guidance to address a number of concerns. The issues to be resolved include defining the “essential health benefits” that must be offered by all insurers; deciding which dependents are entitled to stay on their parents’ insurance; determining who qualifies for a “hardship exemption” from the requirement to have insurance; and deciding who is eligible for a new long-term care insurance program.

    As originally conceived, most of the new federal requirements would have taken effect at the same time, in three or four years. The requirements for people to carry insurance, for employers to offer it and for insurers to accept all applicants were tied together.

    But as criticism of their proposal grew, Democrats wanted to show that the legislation would produce immediate, tangible benefits. So they accelerated the ban on “pre-existing condition exclusions” for children.

    Consumers will soon gain several other protections. By July 1, the health secretary must establish a Web site where people can identify “affordable health insurance coverage options.” The site is supposed to provide information about premiums, co-payments and the share of premium revenue that goes to administrative costs and profits, rather than medical care.

    In addition, within six months, health plans must have “an effective appeals process,” so consumers can challenge decisions on coverage and claims.



    Insurers Might Delay Covering Pre-Existing Conditions - NYTimes.com



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  4. #4
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    Health insurance companies are evil.

    It's great this health plan will help many, however, we are not included. That's okay. I would rather help some, than none.

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    Elite Member Grimmlok's Avatar
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    Yes, they are evil, which is why single payer or a public option would have been the best solution instead of shoveling sick people into the maw of these companies.
    I am from the American CIA and I have a radio in my head. I am going to kill you.

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    Elite Member Just Kill Me's Avatar
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    Damnit, this is real reform yall! I was listening to Michael Moore: Healthcare Bill "A Victory for Capitalism"

    So, $100 a day fine for not covering pre existing conditions, that'll show them!
    KILLING ME WON'T BRING BACK YOUR GOD DAMNED HONEY!!!!!!!!!!

    Come on, let's have lots of drinks.

    Fuck you all, I'm going viral.

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    Quote Originally Posted by Just Kill Me View Post
    Damnit, this is real reform yall! I was listening to Michael Moore: Healthcare Bill "A Victory for Capitalism"

    So, $100 a day fine for not covering pre existing conditions, that'll show them!
    That still does not help those in that category. This includes those who take meds for minor things such as maintainance drugs, such as high blood pressure, replacement hormones, etc. Oh but how much does anyone want to bet Viagra is totally taken care of!

  8. #8
    Elite Member Just Kill Me's Avatar
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    In what category? This shit doesn't really help anyone; it's a fucking joke.
    KILLING ME WON'T BRING BACK YOUR GOD DAMNED HONEY!!!!!!!!!!

    Come on, let's have lots of drinks.

    Fuck you all, I'm going viral.

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