Newborn denied health coverage over ‘pre-existing condition’
Children might not receive protection from ‘pre-existing exclusion’ until 2014: AP
Houston Tracy was only a few days old when he ran into one of the most controversial elements of the US health care system: Being denied coverage for a “pre-existing condition.”
The newborn from Crowley, Texas, near Fort Worth, was diagnosed with a condition known as d-transformation of the great arteries. The two major vessels that carry blood to and from Houston’s lungs are reversed. Oxygen-rich blood flows back to the lungs; oxygen-starved blood flows through his body instead, damaging his heart.
Shortly after his March 15 birth, Houston’s parents, Doug and Kim Tracy, were notified by BlueCross BlueShield of Texas that their son doesn’t qualify for health insurance because of his “pre-existing condition.”
“How can he have a pre-existing condition if the baby didn’t exist until now?” Doug Tracy asked the Fort Worth Star-Telegram.
The Tracys’ health care situation is somewhat complex. According to the CBS affiliate in Dallas, the Tracys are small business owners who can’t afford health insurance for themselves. They did, however, purchase plans for their two other children.
BlueCross BlueShield told the Star-Telegram that a newborn can be added onto a family health plan without an assessment of its eligibility within 31 days of the child’s birth — but only if the parents are also on the plan. Since the Tracys weren’t themselves on the plan, Houston had to undergo an assessment. And, evidently, he failed the insurer’s standards.
The Star-Telegram notes that the Democrats’ recently-passed health reform law comes several months too late for Houston — the provision banning insurers from denying coverage on the basis of “pre-existing conditions” doesn’t come into effect until September.
But whether or not Houston would have received coverage even if he had been born after September is a matter of some debate. The Associated Press reports that some health care advocates and insurance companies are saying that “the law does not clearly state that such protection starts this year.”
If it doesn’t, uninsured children with pre-existing conditions might not get help until 2014, when the law requires insurers to issue policies for all applicants regardless of health condition. There is no doubt that for children who are enrolled in insurance plans, the new law bars insurers from excluding coverage of any pre-existing conditions.
In response to the concerns, the Obama administration is reportedly planning to issue “clarifying regulations” which will assert that children can’t be denied coverage for pre-existing coverage as of this year, AP reports.
“To ensure that there is no ambiguity on this point, the Secretary of HHS is preparing to issue regulations next month making it clear that the term ‘pre-existing exclusion’ applies to both a child’s access to a plan and to his or her benefits once he or she is in the plan,Ã¢â‚¬Â said Health and Human Services spokesman Nick Papas.