Newborn With Pre-Existing Condition Gets Coverage

[sabra]

Source: ABC News

Insurance Company Offers to Pay for Newborn Caught in Insurance Coverage Gap

April 2, 2010—

Houston Tracy made the rounds on national blogs before he was even a month old.

At 12 days old, he already had survived a rare birth defect, a feeding tube and open-heart surgery.

But his family was in a battle with an insurance company to get his surgeries covered. His parents, Kim and Doug Tracy of Crowley, Texas, didn't have health insurance for themselves. The Tracys said insurance agents assured them they could buy health insurance for Houston once he was born.

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

Doug Tracy, 39, called his congressmen. Then the local news media spread the word.

...

Soon, Darren Rodgers the C.E.O. of Blue Cross and Blue Shield Texas called Tracy too. Within a few days of negotiations, Tracy said he had a letter from Rodgers that promised to pay for Houston's surgery and offered him insurance coverage.

Read more: http://abcnews.go.com/Health/HeartFailureNews/newborn-pre-existing-condition-coverage/story?id=10264490

[jody]

1. OK but how many other new borns were denied insurance for pre-existing conditions by BC-BS TX et al?

[elehhhhna]

3. No press coverage = no insurance coverage. USA! USA!

[jody]

4. Agree do something for PR and ignore thousands of other infants. n/t

[BlueIris]

15. DUzy.

Nice work.

[Fridays Child]

2. Nice P.R.

How many have died for want of the same consideration?

[SocialistLez]

6. Yep yep

More people should go to the media or heck, even Youtube and SHAME these horrible health insurance companies.

[Bill_Segundo]

5. a partial birth abortion three weeks back would have saved money

If the goverenment is going to decide who gets coverage for what via all those extra IRS agents we're going to have to decide what a baby's life is really worth. The cost of saving that one life could have saved thousands in Africa. The Brits have a 22 day cutoff. What would ours be? I don't know, but we'll have to start thinking about it.



http://www.dailymail.co.uk/news/article-1211950/Premature-baby-left-die-doctors-mother-gives-birth-just-days-22-week-care-limit.html


'Doctors told me it was against the rules to save my premature baby'
By Vanessa Allen and Andrew Levy
Last updated at 8:53 AM on 10th September 2009

Comments (642) Add to My Stories
Doctors left a premature baby to die because he was born two days too early, his devastated mother claimed yesterday.
Sarah Capewell begged them to save her tiny son, who was born just 21 weeks and five days into her pregnancy - almost four months early.
They ignored her pleas and allegedly told her they were following national guidelines that babies born before 22 weeks should not be given medical treatment.


Read more: http://www.dailymail.co.uk/news/article-1211950/Premature-baby-left-die-doctors-mother-gives-birth-just-days-22-week-care-limit.html#ixzz0jyx2kQUF

[SocialistLez]

7. ??!!

DID YOU NOT READ THE HEADER??

IT WAS THE HEALTH INSURANCE COMPANY THAT MADE THIS DECISION, NOT THE GOVERNMENT!!!!

I've heard the Daily Mail is like the National Enquirer of the U.K.

[Bill_Segundo]

8. Guidelines are guidelines. The company doesn't write the guidelines.

When we have a national guideline it will be the same for us. So it's time to start thinking about those guidelines.

[VAliberal]

9. the health insurance cartel has, until the health reform legislation,

been unregulated. They wrote their own rules. They made decision based on the bottom line. Their motive was and is profit - not health care.

[Bill_Segundo]

11. Cost will still be a factor. It always is. Preemies are expensive.

There's reason not to spend a lot of money on premature babies. And the money that goes to one mostly comes from someone else.


http://www.guardian.co.uk/society/2007/feb/21/health.lifeandhealth

A 1995 study quoted in the Nuffield report records that of 138 babies who showed signs of life after being born at less than 22 weeks, only two survived to be discharged, and a follow-up at six years of age found that one of those two had severe disabilities, classed as "likely to make a child highly dependent on care-givers, and involving one or more of the following symptoms: cerebral palsy that prevented the child from walking, an IQ score considerably lower than average, profound sensorineural hearing loss, or blindness." (The other child was classed as mildly disabled.) Quite apart from the state of the child, such levels of disability cause great stress to the parents and to their relationship.

[deek]

36. Good luck to you

and your present/future children/grandchildren. Perhaps you'll regrettably remember your words someday.

[izquierdista]

24. My guideline

Says to ignore the stupidity that you post.

[Bill_Segundo]

26. Well played.

I bet you never lost a debate with skills like that.

[kestrel91316]

21. You might want to rephrase that. There's no such thing as a "partial birth abortion".

There IS such a thing as a late-term abortion, and the techniques include intact dilation and extraction, which is erroneously called "partial birth abortion" by the medically ignorant with christofascist leanings.

I'm quite sure you wouldn't want anybody here to think you were one of THEM, right??

[Bill_Segundo]

25. Sure, we can call it late term

Or whatever else. I'm not worried about debating that point and am more than willing to concede it.

I'm just one of me. It's why I'm reticent to spend a lot of time on a site dedicated to everyone having close to the same position on everything. Invest emotional capital making friends, developing arguments and positions, and go too far against the grain, boom, you get banned and you've wasted a load of your time.

How pro-choice does one have to be to remain a member in good standing? If I'm pro-gay marriage but against one-payer am I still in the ballpark?

I'm not good at going along to get along because I don't limit my interactions to political allies. Not enough people agree with me on everything to have that luxury.

I do like the christofascist thing though. Another guy used to call it Christ-psychosis. Even accused Jews of it. A fascist in a mold all his own.

[Crunchy Frog]

31. There's not a doctor in the entire country who would have aborted that baby

three weeks before he was born.

The right wing has so many misconceptions about these things that it would be laughable if it wasn't so sad.

[Bill_Segundo]

32. Of course not

That wasn't the point. Aborting that baby and not doing anything to save it wind up with the same outcome. The chances of survival are very low. I posted a link about it.

Can we really afford to save every extreme preemie when children are dying for lack of cheap things like clean water?

[Crunchy Frog]

33. Actually, not doing anything would not have been an option either,

because of the "Baby Doe" laws. It would have been illegal not to treat. The insurance company just wanted to leave the family destitute from the costs of treatment, or have the hospital eat it, and then maybe have the baby die down the road from not being able to get routine followup treatment.

The issues of trying to save preemies at the margins of viability are a completely different topic, and complex far beyond the related expenses, which have absolutely nothing to do with the provision of clean water in third world countries. It's a very dishonest debate tactic to mix up issues that have nothing to do with each other. Something that I expect to see from right wingers.

[Crunchy Frog]

27. I think you mean 22 week cut off. News bulletin:

They don't try to save babies before 22 weeks in the US either. That's because they are not viable at that point and it's an exercise in pure cruelty.

Here's an excerpt from a fascinating blog post by a NICU nurse on this subject:

From reading the UK Mail Online article, and more importantly reading the over 600 comments on this topic, it has made me painfully aware of the ignorance, naivete, and anger the public perception is of caring for infant’s at the edge of viability. Nowhere in the world, including the United States( which arguably had the most advanced technologies when it comes to NICU care), is it routine to resuscitate infants below 23 weeks gestation. In the United States, guidelines for initiating resuscitation vary from 23-24 weeks, and 450 to 500 grams. These guidelines vary by state. Contrary to what Ms. Capewells web page states, it is not “government legislation” that dictates whether an infant born before 22 (really 23 weeks) will be resuscitated and admitted to the NICU. It is the physicians and staff at the delivery. If we are called to a delivery for unsure dates between 22-23 weeks, (the NICU team does not attend deliveries between 21-22 weeks) we first counsel the mom on what will happen and give her as much information as possible, regarding outcomes and survivability. Her choices are to do nothing and provide only comfort care, to start resuscitation until the baby “declares” himself, either by improving or decompensating, or request a full blown resuscitation. The physician’s at the delivery will assess the infant and it is ethically and legally appropriate to withhold or stop a resuscitation on such an extremely premature infant based on how the infant presents himself.

~snip~

I have cared for many infants at the edge of viability. It is always emotionally draining. There is no justice to it. The extreme measures involved to keep a 22-23 week infant alive is staggering, and it is ugly. I once had a patient who had an IV placed on the side of her knee due to such poor IV access. When that IV infiltrated, I gently pulled the catheter out, and her entire skin and musculature surrounding the knee came with it, leaving the patella bone exposed. I have seen micro-preemies lose their entire ear due to scalp vein IV’s. I have watched 500 gram infants suffer from pulmonary hemorrhages, literally drowning in their own blood. I have seen their tiny bellies become severely distended and turn black before my very eyes, as their intestines necrose and die off. I have seen their fontanelles bulge and their vital signs plummet as the ventricles surrounding their brains fill with blood. I have seen their skin fall off. I have seen them become overwhelmingly septic as we pump them with high powered antibiotics that threatened to shut down their kidneys, while fighting the infection. I have seen many more extremely premature infants die painful deaths in the NICU, then live.

http://realityrounds.com/2009/09/15/is-letting-a-21-week-premature-baby-die-considered-health-care-rationing/

My own babies were born at 33 weeks and 3 days. I would not have tried to save them if they had come before 24 weeks.

[tavalon]

29. As a NICU nurse, I thank you for posting this

Many laypeople think there is no limit to what modern medicine can do for premature babies but in fact, there is a hard line which we can't go beyond and as we dance upon that line, it's the very premature babies who suffer.

[Quantess]

37. Mom apparently didn't want an abortion. Tell us more about the "death panels", Sarah Palin.

And no, the dailymail is not a reliable source.

[Optimistic]

10. Maybe this will start a trend,

Since The health Care Bill uses the Insurance Companies They will want to be part of covering everyone, If they deny coverage to anyone like this it would be bad for business and they will not be included in the exchanges, So maybe the insurance companies will start becoming Good Corporate Citizens Then again maybe the Los Angeles Clippers will win the NBA crown too.

[Bill_Segundo]

12. The idea is to drive them out of business.

But the problem remains. We have unlimited wants and limited resources. How does the government best dole out the resources if we're not going to have a free market and instead will have government mandate everything.

[skyounkin]

13. Take 5% away from the bottomless pitt called

the defense department spending bill.

Problem solved.

[Bill_Segundo]

14. That might cut our debt some, but we're already behind.

The problem still remains, we're deep in debt, have unlimited desires and a limited ability to spend. Cut the DOD 10% and we're still in debt and still have to decide what we can afford.

[Celebration]

17. Repeal the Bush tax cuts

That's a start.

Of course any health care system there will be rationing. Insurance companies ration now. It doesn't make economic sense to spend ten million dollars on preemie care for a 1% chance of survival. It's sad, but no country, OR insurance company, has that kind of money for something like that.

[Bill_Segundo]

18. There you go.

A reasoned response, that whether I agree or disagree was logical. Folks that applaud a private company for approving care that a universal system of government managed care will probably turn down are being illogical at best. Dishonest for political reasons at worst.

[The Green Manalishi]

19. From what I can see there are 3 types of rationing

1- health insurance industry executives and actuarials set the rules.
2-government sets the rules
3-free market sets the rules,(assuming one can break up and break the grip of those in option 1).

Somehow or another, some mechanism will allocate a finite supply against a larger demand.

[Bill_Segundo]

20. The problem is the finite supply and infinite demand.

Personally I'm for greater freedom, to increase supply. As is the government keeps as many people from care and medicine as they help to it. Make more meds over the counter, train more nurses and let them provide cheap prescriptions for basic stuff. No reason to force people to pay for a hundred dollar doctor visit twice a year to get the same old $4 a prescription meds. No reason to force people to take an ambulance to dialysis, no reason to let doctors and medicine producers to write laws, and lock citizens out.

Most stuff people should pay for. Then they care what they get and what it costs. When a third party provides every bandaid, suddenly things get expensive.

[christx30]

28. Also no reason to force insurance companies

to cover stuff that is not necessary. Why should I pay for coverage for erectile dysfunction or alcohol treatment? I do not have any of the conditions that would necessitate that coverage. I'm healthy and I don't drink. The government should allow me to choose a plan that will pay for 2 wellness checks per year, and any emergency treatment I might need.
But we are going to be saddled with a whole hell of a lot on our plans, forced to buy stuff that we don't need. This is going to jack up premiums and piss off a lot of people.

[Bill_Segundo]

34. Government IS force.

Once it takes over and tells you what you MUST buy it's too late to complain.

This is law, you can't pick and choose now. That's why I was against a one size fits all monstrosity from the start.

[christx30]

35. As was I

But a lot of people here on DU wanted a victory over the repubs, and got this. So the choice is either grin and bare this horrendous law, or support those that are trying to get it repealed. There are better ways of getting access to healt hcare to more people without forcing everyone to have health care, or fining employers for not offering it. Now there are going to be a lot of small businesses that are going to put a freeze on hiring or even lay people off so they can stay under the 50 person limit. Or they will get workers from temp agencies. If I'm wrong about anything I'm saying, please correct me. But I think this is going to hurt a lot. Especially for someone like me that is under employed (I only work 35-40 hours a week, making $9 an hour), and raising two awesome kids.

[Celebration]

16. there is rationing now

Insurance companies routinely turn down procedures now that don't fit their guidelines.

What we have now in health care is about the farthest thing possible from a "free" market. Nowhere close!

[kestrel91316]

22. We can easily afford healthcare for all if we tax the rich the way they were

when Saint Ronnie was in office, or maybe even as much as we tax the poor and middle class.

[Bill_Segundo]

23. The middle class does ok

The poor are the ones that get it the worst. They pay sales taxes equal to what the rich and middle class do, on a lot less disposable income. They also pay all the hidden taxes and fees politicians hide when they don't want to hike tax rates. Sure, they don't pay much income tax, but with all the other taxes there isn't much disposable income left to tax.

[Crunchy Frog]

30. The reform calls for a market, just a regulated one.

The market is still allocating resources, the government is just imposing some basic ground rules. So far as I know, there is no limit on what an insurance company MAY provide, only some minimum standards on what they MUST provide.

BTW, a large percentage of NICU babies are on Medicaid, ie socialist government healthcare. They are the lucky ones, since Medicaid basically covers everything. The families with private free market insurance are the ones that tend to get screwed.