Crowley, Texas - Newborn Baby Denied Insurance Due To Heart Defect

[Pooky 3,841]

Yes it does and I think that the bay should have automatically been added on birth and neo natal care if the parents had insurance. The costs should have been then spread out to all members on the plan. If we want to join health care plans then we all must share the others costs. We also can't complain if some are hogging more of the outgoing costs. Companies have to make at least a break even point. Some profits are needed to service infrastructure and rainy day funds. If you want a strong company and need investors then you have to be able to promise some kind of return on investment or no one will invest and that can spell no companies that can offer these services.

Got to disagree with you there. Overhead is separate from profit and is part of the operating cost. Profit is what goes out as dividend and in as investment, which is rather different from maintenance and fallback plans.

[luckytxn 2,265]

Disagree all you want but those maintenance costs are general operating costs. All companies earmark a certain percentage of profits to be set back for an emergency fund. Infrastructure spending is done by trying to guess what the profits will be and the needed infrastructure spending then earmarking the spending. The spending then moves from profits to general funding.

[Rebecca Jo 1,962]

Of course pre existing conditions can cost a lot of money. Costs have to be passed on so prices will be spread across to everyone. Of course since insurance companies need to at the least break even to survive then what happens if they start not making any profit? They will go under and then all will lose their coverage. This means that the Socialists will now win and be able to say that the Feds are the ones coming to the rescue and have to handle their health care. It is all steps for total take over.

You do understand that for at least the last decade, 20 cents of every dollar of your insurance premium has been going into stockholders pockets, don't you? Not into "recovering the cost" spent on a pre-existing condition, but into pure profits. Not even going into paying the huge salaries of insurance executives. Those two dimes multiplied by millions of dollars have gone into paying stock dividends.

You really shouldn't comment on Socialism until you understand Capitalism, you know.

[luckytxn 2,265]

You do understand that for at least the last decade, 20 cents of every dollar of your insurance premium has been going into stockholders pockets, don't you? Not into "recovering the cost" spent on a pre-existing condition, but into pure profits. Not even going into paying the huge salaries of insurance executives. Those two dimes multiplied by millions of dollars have gone into paying stock dividends.

You really shouldn't comment on Socialism until you understand Capitalism, you know.

And you are totally wrong on that. there is no 20 percent profit for the health care industry going into the share holders. You seem to need to learn your facts before you spout off about what you know nothing about.

[luckytxn 2,265]

Still waiting to see the facts about the big old profits ending into share holders pockets being 20 percent.

[Pooky 3,841]

And you are totally wrong on that. there is no 20 percent profit for the health care industry going into the share holders. You seem to need to learn your facts before you spout off about what you know nothing about.

Agreed that 20% is too high. IIRC, the figure is about 4%. But any money leaving the system is an inbuilt inefficiency. Add to that the inbuilt mechanisms to deny coverage, both before and after care has been received and anyone can see that removing the private insurance companies from the primary level of care will both reduce costs and provide a more balanced type of healthcare system - a system where newborn babies' lives are not held ransom to the $$$$$.

[luckytxn 2,265]

Agreed that 20% is too high. IIRC, the figure is about 4%. But any money leaving the system is an inbuilt inefficiency. Add to that the inbuilt mechanisms to deny coverage, both before and after care has been received and anyone can see that removing the private insurance companies from the primary level of care will both reduce costs and provide a more balanced type of healthcare system - a system where newborn babies' lives are not held ransom to the $$$$$.

Finally the right figure comes out. So lets see though you say that removing the private insurance companies will reduce the costs? How is this going to happen? There is a huge Federal and state bureaucracy that will need to be fed. Are you trying to say that the profit motive is being taken out of the equation? Interesting but the facts historically have always been the opposite. The inefficiencies of huge bureaucracies usually more than eat up these so called savings. Do you know why huge Federal and state bureaucracies eat up these so called savings?

[luckytxn 2,265]

That 20 percent was thrown out early by the Socialist as a talking point a long time ago to scare the people but was quickly shown to be false and it has been over a year since anyone tried to pull that figure out of the air. Some seem to be way behind the curve. It shows that the koolaid is very strong and some have bot woken up yet.

[Rebecca Jo 1,962]

Still waiting to see the facts about the big old profits ending into share holders pockets being 20 percent.

"A study conducted last year by PricewaterhouseCoopers revealed just how successful the insurers' expense management and purging actions have been over the last decade in meeting Wall Street's expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients."

From the congressional testimony of Wendell Potter, a former CIGNA executive.

http://www.pbs.org/moyers/journal/07102009/potter_testimony.html

[Pooky 3,841]

Finally the right figure comes out. So lets see though you say that removing the private insurance companies will reduce the costs? How is this going to happen? There is a huge Federal and state bureaucracy that will need to be fed. Are you trying to say that the profit motive is being taken out of the equation? Interesting but the facts historically have always been the opposite. The inefficiencies of huge bureaucracies usually more than eat up these so called savings. Do you know why huge Federal and state bureaucracies eat up these so called savings?

FFS don't mention Federal bureaucracy. Single payer should never, EVER, be a Federal responsibility.

State level is far more manageable and, in some part, is already in place. As for inefficiencies, you think that the number of "Health claims specialists" that abound are efficient? Don't make me laugh! They are there for one reason, and one reason only, and that is to uncover deniable claims, for whatever reason, and do just that - deny them.

Healthcare needs to get away from being a business and back to being about health, a factoid that both sides in the recent "healthcare" reform debate conveniently forgot.

[luckytxn 2,265]

"A study conducted last year by PricewaterhouseCoopers revealed just how successful the insurers' expense management and purging actions have been over the last decade in meeting Wall Street's expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients."

From the congressional testimony of Wendell Potter, a former CIGNA executive.

http://www.pbs.org/moyers/journal/07102009/potter_testimony.html

This is not even mentioning profits but cost savings that lead to higher profits. Keep trying though because I have done the searches and the profits have been historically 4-5 percent always.

[SunDrop 59]

It said that they paid for her neonatal care. The situation with her son's heart might have been viewable during a fetal biophysical profile at a neonatalogist's office, but only if he was probably in his last few months. Most women normally don't have biophysicals done on their fetuses, just the 5 month one to check to make sure all organs are accounted for. The profiles are reserved for women who are in high risk pregnancies.

And this is incorrect terminology. The baby receives neonatal care, the mother receives pre- or ante-, peri- and post-natal care.

The mother wouldn't have been seen by a neonatologist during pregnancy unless they knew there were a problem and even then, their involvement would have been with the baby as their patient.

And sadly, this isn't a "new" situation by any stretch of the imagination. Every woman is different and every pregnancy she has is different. You can have several "perfect" pregnancies and then be whammied with a difficult one. Equally, you can have several problematic pregnancies and then have one that should statistically be high-risk and it be fine. They are incredibly difficult to predict and this is the reason why so many women discover that pregnancy isn't covered by their policies, because actuaries would rather just exclude them rather than try and put a price on them for premium costs.

And for the "what are they doing having another baby" sayers... there are so many factors involved in pregnancy and insurance, you really can't judge them on the basis of one article. The likelihood is that they couldn't get insurance, for either the pregnancy or the birth. The irony of this is that if they genuinely couldn't afford this baby, and so were pre-qualified for medicaid, the baby would be covered too. This isn't a "why the heck not" procedure; without it, the baby won't survive.

I have many friends who've been taken to the point of bankruptcy as a result of an unexpected complication in pregnancy. All it takes is to have experienced a premature birth and you soon have a catalogue of veritable horror stories. With the increase in assisted conception and therefore multiples, we're going to see more premature births. These kids aren't a blight on society; they're going to end up being tax (and pension) paying, contributing members of society.

[luckytxn 2,265]

FFS don't mention Federal bureaucracy. Single payer should never, EVER, be a Federal responsibility.

State level is far more manageable and, in some part, is already in place. As for inefficiencies, you think that the number of "Health claims specialists" that abound are efficient? Don't make me laugh! They are there for one reason, and one reason only, and that is to uncover deniable claims, for whatever reason, and do just that - deny them.

Healthcare needs to get away from being a business and back to being about health, a factoid that both sides in the recent "healthcare" reform debate conveniently forgot.

Agree. And I also agree about the pre existing conditions as stated before. As also stated before it should be passed along to all members. A company has to make money. We can't tell a company that they have to now accept pre existing conditions and they have to not charge MORE to cover the additional costs that will be needed. If you do this then the company will go bankrupt.

[Rebecca Jo 1,962]

This is not even mentioning profits but cost savings that lead to higher profits. Keep trying though because I have done the searches and the profits have been historically 4-5 percent always.

A dollar is a dollar, funny man.

And since you asked for proof, why don't you show us yours that proves a measly 4-5 percent profitability.

[Pooky 3,841]

A dollar is a dollar, funny man.

And since you asked for proof, why don't you show us yours that proves a measly 4-5 percent profitability.

Then I take it that you can't back up the 20% figure? Because if they were making 20% profit, you could bet your life that media wouldn't be harping on the pre-existing conditions in place of the unethical profit margins.