Question about pre-existing conditions

[GKirk]

There has been discussion about insurance companies denying coverage to babies
because they are born with a pre-existing condition like a heart ailment or something.

Is this actually happening to people who go into the hospital with insurance in place?
If so how?

[rucky]

1. here's the article...

http://www.mcclatchydc.com/2010/03/26/91120/texas-newborn-denied-health-insurance.html#Comments_Container

It's hard to tell from that if they were already insured or not.

[GKirk]

2. In the meantime...

...I found this link
: http://www.cbsnews.com/stories/2010/03/29/national/main6343757.shtml
which certainly seems to say that the parents went in with coverage and
left with an un-insured baby. But this must be a very rare thing. Or am I
mistaken?

[SoCalDem]

3. Many times, insurance has "fine print" about births

often not starting "official coverage" until the 10th day (or some other made up date).. The "birth" is considered to be a medical cost for the mother, who IS insured, but the actual baby's coverage does not begin until they are officially "added" to the policy..

Mine are all grown now, but I recall seeing some wording to the effect of "normal well-baby care"...obviously a baby who is not "well" ...could fall outside this parameter:(

[libertad]

5. well baby care means check ups and shots, not the status of the

baby.

[Nikki Stone1]

9. +1

.

[libertad]

6. in the article it states that they only cover their children...

From article: "The Tracys are small business owners and do not carry health insurance for themselves. They do carry insurance on their two other children and tried to get insurance for Houston..."

[libertad]

4. in the article I read, they said the parents were not insured, but

wanted to insure the baby. Because of medical underwriting, the child could not qualify for insurance due to the heart condition.

[Lint Head]

7. Please understand that the term 'pre-existing condition' was totally

invented by the insurance industry. It use to be called a 'complication'.

Because a particular health condition exists prior to treatment for any other health issues it has to be taken into account by the doctor. It is never a reason for the doctor to deny treatment. I have one kidney. That would complicate any other surgery I may have because substances can damage my one and only kidney. An insurance company can deny me because they have defined that as a 'pre-existing condition'. It is a money making concept wrapped in a term to make it more acceptable. It is not a medical term but an insurance term.

Insurance companies are the essence of greed. They will find any reason to make a profit even it is to deny service.

[SoCalDem]

8. Life is a pre-existing condition.. EVERYONE gets sick and everyone will die from something.

the whole pre-existing condition thing is outrageous and must be stopped.

This is why we need a tax-funded universal plan that covers everyone, and that everyone pays into through taxes.. It would eliminate the insurance companies as the lord-almighty-overseers. It turns the whole process from "micro" to "macro", and no one group gets singled out...or demonized as "costing too much", or "causing MY rates to go up"..

Insurance companies could still exist, as an adjunct , for people buy buy policies that would guarantee them private rooms, or to pay for cosmetic surgeries, or perhaps fertility treatments.

All insurance companies should morph into "gap" insurance..not primary..

[GKirk]

10. This makes sense to me...

...as to why insurance companies have done this in the past.
"the whole pre-existing condition thing is outrageous and must be stopped"
as long as people aren't required to have insurance it's completely understandable.
It would be like not buying car insurance until you wreck your car.
Insurance companies don't like to 'buy' claims.

[PA Democrat]

12. If you have to buy an individual policy (self-employed or company doesn't offer group insurance)

you can be denied for a preexisting condition even if you have always had health insurance. If you change insurers, or go from group coverage to an individual plan you can be denied coverage for a "preexisting condition" even if you never had a gap in coverage.

And then there is the issue of how companies will scour your past health records looking for any excuse to claim a serious illness is preexisting. They will misconstrue ANY innocent symptom you reported to your doctor in the past as proof that your current illness is "preexisting." In fact they pay bonuses to claims processors who deny the highest percentage of claims.

[HipChick]

11. It doesn't always mean you have an actual condition..

I was laid off from my job..it was some months before I could get another and get health insurance...everytime I went to the dr or hospital, my claims would get ""Pre-Exisiting condition" because I had a break in health insurance..