'GMA' Gets Answers: Newborn Baby With Pre-Existing Condition?

Source: ABC News

New mother Kelly Barnes is heartbroken and angry.

She's heartbroken because she has endured what no mother should have to endure. While pregnant with twins, she lost one of them at 30 weeks. The other baby, Kinsleigh, was born with serious heart problems.

But Barnes is angry because her insurance company, Aetna, held up paying thousands of dollars in medical charges. The reason? The insurance company said the newborn might have been suffering from a pre-existing condition.

"I don't know how something could be pre-existing in a baby, so it was very shocking to me to see something like that," Barnes told "Good Morning America." "It's a slap in the face. Her medical bills are the last thing I should be worrying about. I should know that my baby is being taken care of."



Read more: http://abcnews.go.com/GMA/TheLaw/answers-baby-denied-medical-coverage-womb/story?id=11871449

---

Hey Kelly, don't you know according to Repukes like Palin, Angle, Rand Paul, Joe Miller, O' Donnell, sorry but once the baby is out of the womb the two of you are on your own - the freemarket will take care of it.

be mistaken for the other.
Health care for profit is health profit against all care.

that is not the hospital, not the government

that is a for-profit company getting between YOU and your DOCTOR (in this case between YOUR BABY and TREATMENT)

listen up you Tea Baggers


"Aetna"

hear it
learn it
stop lying about it

insure a 'house that has already burned'", ie: cover anyone with a preexisting condition.....

your baby is nothing more than an already burned down house.....not worth insuring.

people forget that "pre-existing conditions" don't just happen to 60 year olds. This is a case that makes a very powerful point to how broken the current system is, when a new mother has to worry about both if the child's heart defects will be fixable, and then if there'll be money to feed and shelter the family afterward.

She needed surgery for a congenital birth defect. Nothing serious, but critical she have it, both for proper physical development and aesthetic concerns. We looked around, found one idiotic doctor we rejected, then hooked up with a genius at LA's Children's Orthopedic who fixed it straight away.

That's when our troubles began.

Insurance denied the claim. It was a "pre-existing condition," they declared. I said no, it was congenital, so unless they intended to engage in a "which came first -- chicken or egg" argument, it was simply a condition of my daughter's life, easily correctable through surgery, and should be covered. "Denied," they proclaimed from on high. And that would probably have been the end of it, for most people, except . . .

My brother's an attorney and I don't like to lose, especially in a game rigged against me. We badgered and chawed 'em from quite a few directions until at last they relented and paid their share, the share I'd contracted with them for when the policy was issued.

But how many people, lacking either education or connections, simply throw up their hands and resign themselves to their denial? And how often do insurance companies routinely write such denials, confident that at least percentage of them (probably a hefty percentage, as well), will simply be accepted by the citizen, who sees it as just "rotten luck" or some such rationale?

Health insurance is a scam and its purveyors nothing more than well-dressed thugs. It should be done away with, straight away. Single payer now!

:applause:

fighting. A few years ago, my ex husband was laid off and got another job, which meant no insurance for the kids for fourteen months because United Health Care would only let new hires apply for insurance in a particular month, after they've already worked for a year. My son needed surgery and I called to make sure it was approved before the operation. UHC denied it because they said it was a pre-existing condition and there was a nine month waiting period. The HIPAA law says, "If a plan has a general waiting period and a preexisting condition exclusion period, both time periods must run concurrently" so we had long passed the waiting period for pre-existing conditions. I had to argue with five different levels of 'let me speak to your supervisor', six different days and wound up screaming, "Why do I have to explain to you what the FUCKING law says when it's your job to know? What happens to people who are too old or too sick or just don't know enough to argue with you?!?"

If I hadn't known what the law was, they would not have paid. I truly think that insurance companies routinely deny everything in the hope that people ARE too sick, old or uninformed to fight them.

And it isn't their job to know the law. It is the corporations job to obey the law, but the worker drones within the insurance borg collective are NEVER trained in the law - just in the companies particularly twisted and evil interpretation of how it might be massaged and manipulated in the hopes that they are NEVER caught doing what they do to innocent people every minute of every day.

And they get away with it.

And the truly sad thing is that we have a looming health care crisis in this country because primary care and family doctors are dwindling in number mainly because it is almost impossible to act as a primary care physician and still get paid. I could tell you stories that would curdle you balls into the size of raisins (assuming you had balls - which, based on your story, you do).

Cheers.

Every minute of every day! and in numbers that would shock the hell out of any sane person.

I run a medical clinic and it happens constantly to patients we talk to (we provide a low cost cash option that is 50% of what the insurance option would be simply because it costs us AT LEAST 50% of a claim to collect on it due to time and staffing necessay to bill insurance - in fact the "cash" option is now so much of our practice that we are dropping insurance billing completely).

I used to work for BCBS and I saw it from the inside; supervisors advising claims adjusters (barely above minimum wage / no medical education required / computer screen drones) on how to best deny a claim and still not get sued easily. Standard operating proceedure, based on my experience and on the conversations I have had with friends who still work in insurance companies, is to deny first, second and third and ask questions never. In other words they deny claims KNOWING that they are wrong, in violation of the law and controvening their own policy.

Insurance companies are a pox on the ass of humanity. They should be put out of business and if they aren't then we need; a) new politicians, preferably with spines, and b) to physically go to every insurance company building and burn it to the ground (think the movie fight club for my favorite fantasy about these companies).

I'll get off my soap box now and go get a scotch.

That's a big, big no-no in the insurance industry.

We need your voice!!

(But you can still go have that scotch! :-) )

my husband's office deals with this every day and patient's get so angry because the insurance company lies to them, and we have to tell them that they really don't have that "coverage". I will say it again, I will raise my glass to the day that health and dental insurance companies go out of business and their blood sucking ceo's never draw another dime from the millions of people they have knowing denied coverage to. Burn baby burn.

Health insurance and auto insurance are the biggest legal scams on the planet!

with the claims I've had (granted I've only had 3 in 30 years, none that expensive) - they waived my deductible on the last one even though it was my fault.

Compared to the health insurers I've had, they've been a joy to do business with.

I remember him saying that the United States was the only western, industrialized nation where a child born with a correctable birth defect might just have to live with that defect because of the insurance companies.

THIRTY.YEARS.AGO.

And nothing has changed - even with "reform" the insurance companies will still find reasons to deny claims like these and even with insurance that might pay something, parents may still not have the cash to cover the out of pockets.

When my son was first diagnosed with Dermatomyositis (1991) he spent many months at CHLA. I was like you, had the knowledge (at the time I was in insurance and specialized in group health care plans) and I fought them on every denial (I still ended up losing my home and using all my savings fighting them). Many families I met were forced into medical bankruptcy and onto the medicare roles.

So I'm with you Single payer now!

...and you are totally correct: Unless one has the ammo like an atty brother who has a personal interest in the case, most people walk away from the DENIED stamp on their bills submitted to some Nazi ins co.

Congrats on sticking it to them and sorry that you had to do this to get what you were entitled to get.

Insurance companies assume that the customer isn't going to appeal and if they do, they give up after being worn down to a bloody pulp. I am happy to hear that you had access to a great attorney and knew the right way to fight. Unfortunately so many parents are already tired from having to deal with the medical issues on a 24/7 basis that they just don't know what to do.

Medicare for all!!

If a person-- or a corporation-- makes promises that it will perform a service for a fee, such as covering you when you get sick, and they are proven to be not making good on their end of the contract, and it causes bodily harm, as denying health care plainly does, then someone should go to prison. If its a corporation, they should be shut down or the CEO should be in prison.

But today there are no consequences really. Maybe someone loses money, but actuaries can graph wins/losses and decide exactly how much they should cheat to maximize profit.

Allowing corporations the rights and standings of citizens should be a two way street. If they are immoral, and the mission of any coproration is simply to make money at any cost-- so morality has nothing to do with their existence-- If they are immoral, they should be in prison, or be destroyed. We shouldn't permit them rights which they have a clear mission to abuse. Shame on us for that.

out of laws about consequential damages. They are essentially unsue-able in that respect.

More bad news for all with sick kids.


........



http://www.newsroomamerica.com/story/65015/administration_says_insurers_can_charge_higher_rates_for_sick_children.html


Administration Says Insurers Can Charge Higher Rates for Sick Children

By Jon E. Dougherty at 14 Oct 12:21

The Obama administration said Wednesday that health insurance companies could charge higher premiums to cover sick children after insurers warned earlier this year they would have to drop such coverage because it would become unprofitable under the new health care law.

The New York Times said the administration wanted to encourage insurers to offer the child-only policies and in doing so said they could charge more for them if state law permitted them to do so.

Insurers had warned the administration they would stop offering policies for children with major medical problems because under the government's interpretation of the new law, families with sick children could wait to cover them until the last minute, when children were most ill and headed to the hospital, the Times reported.

Insurance companies "can adjust their rates based on health status until 2014, to the extent state law allows," Jay Angoff, director of the Office of Consumer Information and Insurance Oversight at the Department of Health and Human Services, said...........

into law prevented Insurance companies from denying coverage for pre-existing conditions? WTF, it's like nothing has changed at all!!

... redefine the meaning of the words in that contract. Insurance devils do it all the time.

Trying to get a straight answer out of an insurance company that they will stand behind or even admit to having said, is like trying to nail jello to a wall.

In the few instances I HAVE to talk to someone from an insurance company I record the phone conversation. Someone might tell me that it is illegal to do that without informed consent, but I have talked to the states insurance commissioner, my lawyer, and law enforcement and I am assured that there is not reasonable expectation of privacy for 1 party of a 2 party conversation. So if you record them, don't let them know that you recorded them - that way if you use it, your lawyer can just bring it up during the trail. I always make a point of asking them to spell their name and title within the company as well as telling me employee number, division, or anything else that establishes who I am talking to.

Pardon my French, but when dealing with these devils, fuck 'em. They deserve absolutely no consideration.

So I don't see where any privacy concern would be. They areready told you that the call may be recorded, therefore you don't need to repeat back to them what they have allready said.

do you really think if they told you one thing on the call and did another when it came time to pay the claim that your call would have been one of those taped?

If you do, I have some ocean front propery in western Minnesota you might interested in.

Once all (both) parties to the communication are aware that it may be recorded, any assumptions one of those parties makes about who winds up in possession of any recording(s) is their problem, not the law's.

record the conversation.

I see what you were saying. And now that I get it I have to say that that is an excellent idea!

Insurance companies want to change the English language once again. There are chronic illnesses and acute illnesses.

Acute illnesses are short term, and chronic illnesses are long lasting illnesses, like this congenital heart condition.

If insurance companies do not want to cover chronic illnesses, then what exactly are we paying them for? So they get to decide who lives and who dies? Is this some sort of eugenics?

Let us not allow them to attempt to hide this fact under a false name!

We had genetic testing done, because I knew my father was a hemophiliac. My child had a 50% chance of inheriting it, and I was VERY concerned. Not only because the possibility was there - but because I didn't know how our insurance was going to react if the problem was found.

Luckily, they didn't boot us or him from the policy. But anyone thinking of doing early genetic testing has to deal with the very REAL possibility that while they are doing something good to find problems - insurance companies can and do use them to cut people out of insurance policies.

Move to France! Or Germany! The US hates you and your baby.

Don't count on that changing under the health care legislation that was passed this year. Giving insurance corporations mandatory victims, with no other viable public options, and they will (lawfully) find ways to deny you health care in order to increase profits.

Anybody with a brain should know that.

Apparently Washington is short on brains.....


I read a commentary recently in which the writer compared voting for Republicans and Democrats as this -- choosing to die by hanging or die by drowning. Either way, you still end up dead. Our health INSURANCE system is like that.

They don't care at all about the American people. They want to help insurance companies, because that is how our politicians support themselves.

she had a group policy with dependent coverage. Not everybody's group policy offers dependent coverage -- even if you make an extra payment yourself. And if you try to buy an individual policy for a baby when you're pregnant, you won't be able to -- they'll tell you you have to wait till after the baby is born.

If the baby is born pre-term and requires expensive care, you're out of luck. Your baby has a preexisting condition and no one has to offer a policy . . . until 2014. Unless the law gets repealed before then.

They push every BS routine in the book to avoid paying, and/or to push out the date when they have to pay. They are scum.

Use it to pay off the devil and bribe their way into heaven?

You need your ...

http://en.wikipedia.org/wiki/Aneurin_Bevan

"The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means."
—Aneurin Bevan, In Place of Fear, p100

MEDICARE FOR ALL.

What good is (Obama's) HCR when this happens?????? Totally maddening. :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad: :mad:

Understand how the American public freakin stands for this shit! How can you not all be in the streets over this? I know, I know, half the country is brainwashed and most of the other half is too busy trying to survive. Still, it's infuriating to read this crap. I love my health care system, and I do understand a bit about dealing with insurance companies, since we still need supplemental stuff for dental and prescriptions. The one company wanted $250/month for me and my family, just for supplemental. Ridiculous. It's cheaper for me to pay out of pocket, I just have to hope and pray no one gets cancer and needs a $10,000/month medication. Insurance companies are the epitome of evil. What they do should be completely illegal. It's fraud, plain and simple.

Sheesh. "I'm sorry, but the condition existed during your lifetime, so you aren't covered."

The baby isn't the only one with heart problems.

And now you expect to pay $75 to get it fixed?

I don't want the Amurikan people to simply GET THIS, as a Tea Drinking Republican I want Amurikans to GET OVER IT!!!!!!

Babies are common and cheap to produce. They aren't of special value, defect free copies can be made for less cost and they will be of value in serving the Empire.



I sort of wish this was actually truth free so it could be called what it is...

:sarcasm:

but I have no idea what truth means to the Sith Lords on Wall St or their Mentats in DC.

But some son of a bitch behind a for profit insurance company did...More GOP Lies!The bastards!

health care. These made up terms, like 'pre-condition' should be abolished. If people didn't get sick they wouldn't need them. Since they fought so hard to insert themselves into our Health Care system, they are obligated to do the job of covering SICK people, not HEALTHY people who do not need Health Care.

How did it get to this point? And why do the American people accept this stupidity as if it had any validity? They should be laughed at for their attempts NOT to take care of people's health, and then thrown out of the business.

Of course they never should have been involved in the first place. Health Care is a right, someone turned it into a commodity to be bargained over, and the results have been FATAL for hundreds of thousands of Americans, more than any terrorist could dream of killing.

There really are no words. It is up to the American people who have turned into sheep, willing to take any abuse their government dishes out and worse, try to defend it.

This country needs to take some lessons from European countries, learn how to fight and demand their rightss. This whole debate, with people from the left defending Republican policies, was really shocking. And we have now a system that still caters to the predatory, corrupt, heartless Insurance industry at the cost of lives. There was a chance to put them in their place, instead they were handed control of the issue from the start. They should have been prosecuted for criminally negligent manslaughter, dereliction of duty since they were entrusted with the lives of the American people and failed to protect them.

The whole system is insane, even more insane is the sheeplike acceptance of it by the American people for so long.

Aetna sells a product for a profit. They get you to buy the product that by claiming it will pay your medical expenses* if you get sick . You don't find out about all the weasel words in the contract's fine print until you need to use it.

(*Expenses will be paid after all copays & deductibles have been met, your doctor's office has resubmitted claims at least three times & you're sure that trip to Lourdes failed to help your condition provided the treatment received was considered standard medcial practice in 1800)

You refuse to have a big pharma corp like Monsanto play with your genetic material for some "ameliorations"? Well don't come complaining if the kid gets sick, Pre-Existing Condition! STAMP! Next! :grr:

The next "pre-existing" condition.

My insurance company now says it doesn't exist. So they won't cover my doctor bills.

CFIDS, ME, CFS. The name chronic fatigue syndrome does not begin to do it justice. In fact, they've really changed the definition, so what I have does not fit that definition anymore.

That being the case, my insurance company now says the disease I have doesn't really exist, so they won't cover my doctor bills. They just stopped paying my doctor, because he treats people with CFIDS/ME. That would be chronic fatigue immune dysfunction syndrome, AKA myalgic encephalomyelitis, which has been around for over 50 years in the UK.

For some reason that I cannot fathom, the US government has been trying to cover this disease up since the 1980s. It's a long, complicated story, but first they said this was chronic fatigue syndrome (actually, a governmental committee, none of whom had ever treated anyone with this disease, came up with that name). Then over the years they kept redefining it.

People like me have lots of neurological problems. Brain damage. Short term memory loss. Just to name a very few problems. NIH has kept shifting the definition... until now, CFS does not include neurological damage. They say it's in your heard. But what happened to all the people who do have neurological involvement? There's no "official" diagnosis that covers us anymore. That means no health care.

It was a shell game.

Why is the NIH so intent on doing this?

and cannot imagine the frustration you must be feeling right now.

:hug:

Just curious, 'cause they will. Like this sort of stuff NEVER happened before.

Ironically, THIS is precisely the stuff HCR should have and COULD HAVE fixed.

--------------------------------------

When we live in the most corrupt nation on earth, what else can one expect?

:silly:

Last year I tried to just change programs under the same company. It was basically the same coverage but it was $100 a month cheapers - and that would be a huge help for me.

They gave me such a bad time that I finally just gave up. I was afraid I would get cancelled from the coverage I have and not be able to get other coverage.

When Sharon Angle said (in the debate) that insurance practices like this would be weeded out by the people, I was disgusted. First of all, the lucky ones can only choose from what their companies offer. Secondly, look what's at stake as the market "regulates" the companies. She's naive and short sighted. Not until something devastating happens to her or a loved one would she get it, and even then, I'm sure she'll find a way to blame Obama.

Each day, 273 people die due to lack of health care in the U.S.; that's 100,000 deaths per year.

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

We don't need the GingrichCare of mandated, unregulated, for-profit insurance that is still too expensive, only pays parts of medical bills, denies claims, bankrupts and kills people. Republinazi '93 plan:

"Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."

nt.

Allowing you to purchase insurance accross state lines will lower your rates. Insurance companies are licensed by and subject to state by state regulations (not to mention paying state taxes, operational expenses, etc.). So why do they (insurance companys and repugs)want you to be able to purchase over state lines? So insurance companies can avoid operating within states with stricter insurance regulations, higher taxes, etc. but still reap the sales benefits. Insurance companies are not going to cut each others throats competing accross statelines any more than they do competing within same states.