Newborn denied insurance coverage due to Preexisting Condition.

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.

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.

This is so sad , but what to do . Maybe we should not buy insurance at all after all.

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?