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

[Dan T 8]

A search of the Star-Telegram indicates you are incorrect. Only the original article shows up searching the site. Assuming you are correct, then the parents just got a whopper of a medical bill since the insurance company had decided to deny coverage.

and every free market solution to these very real issues that absolutely need fixing have been ignored in favor of puting another bloated layer of government in between the end-user and health care provider.

[SMR 368]

A search of the Star-Telegram indicates you are incorrect. Only the original article shows up searching the site. Assuming you are correct, then the parents just got a whopper of a medical bill since the insurance company had decided to deny coverage.

We are all such jerks because we refused to pay for this child's health care. What's your excuse? Why didn't you pay for it?

They didn't have insurance. That's why the insurance company refused to pay for it. What's so hard and unfair about that? If you want the insurance company to cover your medical costs, you have to actually have insurance. This family chose not to have insurance, then decided they needed to sign up for insurance when their infant was diagnosed with a heart defect. And then someone writes this sob story because the insurance company was supposed to pay for the operation.

So, back to my original question. Why don't you offer to pay for it? An expectation that you should pay for this condition is as reasonable as the expectation that an insurance company, where they don't have insurance, should pay for it.

Edited March 29, 2010 by SMR

[Empress of Groovy 373]

They didn't have insurance. That's why the insurance company refused to pay for it. What's so hard and unfair about that? If you want the insurance company to cover your medical costs, you have to actually have insurance. This family chose not to have insurance, then decided they needed to sign up for insurance when their infant was diagnosed with a heart defect. And then someone writes this sob story because the insurance company was supposed to pay for the operation.

Their other two kids have insurance. One of the points of this article is that the parents were not aware that they (or perhaps just one of them) would have to have insurance in order to add a child born with a health problem. If the baby had been born healthy, presumably they could have purchased coverage for him. It's not accurate to say that the parents only tried to get insurance for the baby because he needed surgery.

[ready4ONE 5,400]

We are all such jerks because we refused to pay for this child's health care. What's your excuse? Why didn't you pay for it?

They didn't have insurance. That's why the insurance company refused to pay for it. What's so hard and unfair about that? If you want the insurance company to cover your medical costs, you have to actually have insurance. This family chose not to have insurance, then decided they needed to sign up for insurance when their infant was diagnosed with a heart defect. And then someone writes this sob story because the insurance company was supposed to pay for the operation.

So, back to my original question. Why don't you offer to pay for it? An expectation that you should pay for this condition is as reasonable as the expectation that an insurance company, where they don't have insurance, should pay for it.

Wow, what a retarded pile of tripe. Why didn't I personally pay this child's medical bill? Back to the drawing board right wing nut!

[Obama 2012 1,714]

A search of the Star-Telegram indicates you are incorrect. Only the original article shows up searching the site. Assuming you are correct, then the parents just got a whopper of a medical bill since the insurance company had decided to deny coverage.

I'm really wondering if the kid died too... That other article was from Boston and there's been no other news about the kid actually dying... I'm thinking it might have been a BS piece all around.

Another article from yesterday:

http://cbs11tv.com/local/insurance.proposes.offer.2.1595850.html

Blue Cross Blue Shield of Texas announced Sunday that it has "proposed a solution" to the family of a newborn child who was denied health insurance coverage.

Houston Tracy was 10-days-old when Blue Cross Blue Shield denied his family's claim. Tracy was born with a congenital heart defect that caused the two major vessels that carry blood away from the heart to become switched. He underwent surgery to correct the defect shortly after he was born.

The denial came on the heels of Congress' approval of sweeping health care reform that will prevent health insurance companies from denying a claim because of a preexisting condition.

"They kept saying it's preexisting, it's preexisting, but I don't know how it can be preexisting on a baby that was just born." his father, Doug Tracy, said last week. "If it's mandated that everyone have health insurance, than how can one be denied?"

Though no specific details were announced Sunday about the solution, a statement from Blue Cross Blue Shield said the proposal "addresses his and his family's concerns."

Doug Tracy said a deal has been proposed, but not finalized. He is reserving comment

[ready4ONE 5,400]

Wow, what a retarded pile of tripe. Why didn't I personally pay this child's medical bill? Back to the drawing board right wing nut!

I apologize for the harshness of this response. Let me flesh out my thoughts.

We all pay for this sort of for profit insurance skullduggery. In the form of higher premiums, we pay for it. When our insurance company pays $80 for Tylenol, we are paying for those who receive service but can't pay for it. When we all exist with the sword of recision hanging over our heads, we pay for it. When parents are forced to pay out of pocket, are bankrupted and lose their homes, we all pay for it.

It is disheartening to hear those who won't ever achieve billionaire status, and thus the ability to pay ever increasing health care costs out of pocket themselves, parrot the arguments of the for profit insurance industry.

[Dan T 8]

I apologize for the harshness of this response. Let me flesh out my thoughts.

We all pay for this sort of for profit insurance skullduggery. In the form of higher premiums, we pay for it. When our insurance company pays $80 for Tylenol, we are paying for those who receive service but can't pay for it. When we all exist with the sword of recision hanging over our heads, we pay for it. When parents are forced to pay out of pocket, are bankrupted and lose their homes, we all pay for it.

It is disheartening to hear those who won't ever achieve billionaire status, and thus the ability to pay ever increasing health care costs out of pocket themselves, parrot the arguments of the for profit insurance industry.

so am i to take this to mean that it would not satisfy you unless every employee and board member of a private insurence company were making just enough to cover basic living in a $95,000 2 br condo? oh and uh I live in new jersey which means theres no such thing as a 2br condo under $275k in an area thats safe and/or desirable to live in.

Edited March 29, 2010 by Dan T

[Mr. Big Dog 10,747]

Total bunk. We went through this awhile back and showed the real figures. The misleading figures for medicare/medicaid are just the offices handling the payments. Health insurance companies have to figure in costs that seek out fraud detection, fraud enforcement and lawyer fees. Collections of dues and on and on. Medicare/medicaid figures did not show this as it is different federal departments that do this for them. Such as the IRS collects the taxes that pay for it. The FBI that investigates the fraud, the justice department that sues and convicts the offenders and other departments that do the work for medicare/medicaid that the private insurer has to do on their own. When the additional costs were figured in it was shown that they were actually more expensive than private companies and it was due to bureaucratic dimensions.

So fail again as usual.

Fail based on your say so? Let's not get ahead of ourselves here. Riddle me this: Private Medicare plans are paid at 115% of traditional Medicare - i.e. the government pays the private insurance company 15% more than it pays itself for every enrollee. With that, the government offloads the overhead to the private insurance company. But if, as you say, the private insurance company actually operates on a lower overhead than the government, why does the private insurance need more funding per enrollee than the government as a plan administrator? If the private plan is more efficient than the government, it should be able to offer better service and benefits to the enrollee while receiving the same funding as the government itelf.

If Medicare pays more for the outsourcing option than it does for providing the services in-house, then what exactly is the point of this outsourcing?

[SMR 368]

Their other two kids have insurance. One of the points of this article is that the parents were not aware that they (or perhaps just one of them) would have to have insurance in order to add a child born with a health problem. If the baby had been born healthy, presumably they could have purchased coverage for him. It's not accurate to say that the parents only tried to get insurance for the baby because he needed surgery.

And everyone was about to get insurance right before they got sick. I realize that it's a reasonable claim in this case, considering the baby was just born. However, by not buying insurance for all members of the family, they demonstrate that they only buy insurance selectively.

Wow, what a retarded pile of tripe. Why didn't I personally pay this child's medical bill? Back to the drawing board right wing nut!

No, I meant what I said and it makes good sense. The baby is born with a problem. You, for some reason, expect that an unrelated entity, who has no stake in this child's wellbeing and no obligation to help, should be required to pay for the expensive care that the child requires. On what grounds? There is no legal, moral, or ethical basis for the claim that an unrelated entity should be required to pay for the care of the child.

All I'm saying, is that the insurance company has no more obligation to pay for the treatment of an uninsured child than you do.

I apologize for the harshness of this response. Let me flesh out my thoughts.

We all pay for this sort of for profit insurance skullduggery. In the form of higher premiums, we pay for it. When our insurance company pays $80 for Tylenol, we are paying for those who receive service but can't pay for it. When we all exist with the sword of recision hanging over our heads, we pay for it. When parents are forced to pay out of pocket, are bankrupted and lose their homes, we all pay for it.

It is disheartening to hear those who won't ever achieve billionaire status, and thus the ability to pay ever increasing health care costs out of pocket themselves, parrot the arguments of the for profit insurance industry.

You're understanding of economics is lacking. First, when your insurance company refuses to cover someone because there is no way the premium can be higher than the cost, you aren't paying for it. Actually, if the insurance company had decided to cover the infant, then the others insured by the company would be paying for it.

Second, if billionaire status was required to pay for healthcare, on the average, we would all be screwed and no amount of insurance could help us. Insurance (whether private or government option or medicare or whatever) doesn't lower the cost; it just defers the cost. You're right that you have to be very rich to be certain that unexpected illness with expensive care couldn't bankrupt you if you have to pay out of pocket. That's why insurance was invented. But on the average, most people would be able to pay for all of the medical care they need in their life out of pocket if they just took all the money they spend on health care, all the money they spend on premiums, and all the money their employers spend on premiums in their behalf and put it in a tax-free medical savings account. If that weren't true, the insurance industry wouldn't exist.

Now, I'm not saying insurance is a bad thing. Insurance is necessary to avoid bankruptcy in the event of catastrophic medical problems. But insurance only works if people get it when they are insuring risks. You can't insure after the fact. Then you are just expecting someone else to pay for something for no good reason. Hence, why do you expect the insurance company to be the benevolent one? How about you?

[spookyturtle 9,465]

We'll see what happens...chances are, if things does get costly, it will be reformed again. MA for the longest times had set the prices for car insurance, now they stopped that.

And the rates went down when they stopped.

[ready4ONE 5,400]

And everyone was about to get insurance right before they got sick. I realize that it's a reasonable claim in this case, considering the baby was just born. However, by not buying insurance for all members of the family, they demonstrate that they only buy insurance selectively.

No, I meant what I said and it makes good sense. The baby is born with a problem. You, for some reason, expect that an unrelated entity, who has no stake in this child's wellbeing and no obligation to help, should be required to pay for the expensive care that the child requires. On what grounds? There is no legal, moral, or ethical basis for the claim that an unrelated entity should be required to pay for the care of the child.

All I'm saying, is that the insurance company has no more obligation to pay for the treatment of an uninsured child than you do.

You're understanding of economics is lacking. First, when your insurance company refuses to cover someone because there is no way the premium can be higher than the cost, you aren't paying for it. Actually, if the insurance company had decided to cover the infant, then the others insured by the company would be paying for it.

Second, if billionaire status was required to pay for healthcare, on the average, we would all be screwed and no amount of insurance could help us. Insurance (whether private or government option or medicare or whatever) doesn't lower the cost; it just defers the cost. You're right that you have to be very rich to be certain that unexpected illness with expensive care couldn't bankrupt you if you have to pay out of pocket. That's why insurance was invented. But on the average, most people would be able to pay for all of the medical care they need in their life out of pocket if they just took all the money they spend on health care, all the money they spend on premiums, and all the money their employers spend on premiums in their behalf and put it in a tax-free medical savings account. If that weren't true, the insurance industry wouldn't exist.

Now, I'm not saying insurance is a bad thing. Insurance is necessary to avoid bankruptcy in the event of catastrophic medical problems. But insurance only works if people get it when they are insuring risks. You can't insure after the fact. Then you are just expecting someone else to pay for something for no good reason. Hence, why do you expect the insurance company to be the benevolent one? How about you?

Insurance, health insurance, as we have it in this country is a bad thing. Only someone with no understanding of economics, and reality, could possibly defend it.

As individuals we can't possibly individually pay the cost of national defense, nor could we pay as individually for the roads and infrastructure we all use. As individuals we form a collective to pay for things we might not otherwise be able to afford individually. Some things are costly, and not for profit. That is the concept it appears you fail to appreciate. Most of us pay into health insurance but can never really know if we will actually be covered should it be needed.

Maybe Texas is different, but in our state newborn children have a right to health insurance out of the gate. Something like a 30 day window of actually forced coverage under their parents health plan.

The whole system though is retarded on its face, nobody pays more for, and gets less out of, health care than all but the wealthiest Americans verses how other systems across the globe perform. You fail to understand that the system is collapsing on itself and it isn't "we would all be screwed," we have been getting screwed. I bolded the one statement you made I agree on to some extent, however I just don't believe we should collectively play Russian Roulette when it comes to the distinct possibility of catastrophic health problems so that for profit industry can continue to generate said profit. I am unsure how you come to the facts you come to with regards to the original story, and certainly don't comprehend how the parents were irresponsible.

[luckytxn 2,264]

Fail based on your say so? Let's not get ahead of ourselves here. Riddle me this: Private Medicare plans are paid at 115% of traditional Medicare - i.e. the government pays the private insurance company 15% more than it pays itself for every enrollee. With that, the government offloads the overhead to the private insurance company. But if, as you say, the private insurance company actually operates on a lower overhead than the government, why does the private insurance need more funding per enrollee than the government as a plan administrator? If the private plan is more efficient than the government, it should be able to offer better service and benefits to the enrollee while receiving the same funding as the government itelf.

If Medicare pays more for the outsourcing option than it does for providing the services in-house, then what exactly is the point of this outsourcing?

They outsource because they have to. They are nothing but a check writing agency. The outsourced companies do the paperwork and on and on that medicare does not do. That is why they have a small overhead. As stated before private companies have to take in monies. (IRS does it for medicare and that costs but is not figured into medicares costs) Companies have then to take in claims (Along with the insourced loads from medicare) They have departments that look for fraud. (Medicare uses another government agency to do this for them and that costs don't reflect into medicares costs again) If fraud is found they must then either bring charges or sue to collect. (Medicare again uses another Federal agency to do this for them and again this cost is not reflected on medicare) The companies have quality and cost controls they have to look at. (Medicare has the GAO for this and gain the costs of this is not reflected on medicare.

It goes on and on. All these costs when taken into account has shown that medicare/medicaid is more expensive than private companies. Sorry but the small overhead figure is a lie. The costs of the other agencies are there whether we like them or not. It is very disingenuous to try to ignore these things but we can't. Of course the media and Socialists try to ignore the real figures as they would make private companies more appealing.

Also about this time last year we went through this here and we had the same arguments and the same facts. I can try to find it and reply again and we can look at them or do you want me to google the actual figures again put them here to show you? If I remember the costs were about 4-5 percent or higher than private companies.

I never said also that private companies operated at a lower overhead. I said they have to operate as companies. Medicare does also but uses other Federal agencies to do what private companies have to do for themselves. This in itself costs more by not having your own staff but now they have to do the bureaucratic thing and have people do the forms and they go back and forth with different agencies. This is wasteful.

Edited March 30, 2010 by luckytxn

[luckytxn 2,264]

And the rates went down when they stopped.

And in Texas they went up.

[luckytxn 2,264]

Their other two kids have insurance. One of the points of this article is that the parents were not aware that they (or perhaps just one of them) would have to have insurance in order to add a child born with a health problem. If the baby had been born healthy, presumably they could have purchased coverage for him. It's not accurate to say that the parents only tried to get insurance for the baby because he needed surgery.

You are right. They should have been insured from the start regardless if the baby had a birth defect or not. The company was wrong and will now be looking at a huge lawsuit. They had insurance and any bay should have been added regardless.

[Mr. Big Dog 10,747]

They outsource because they have to. They are nothing but a check writing agency. The outsourced companies do the paperwork and on and on that medicare does not do. That is why they have a small overhead. As stated before private companies have to take in monies. (IRS does it for medicare and that costs but is not figured into medicares costs) Companies have then to take in claims (Along with the insourced loads from medicare) They have departments that look for fraud. (Medicare uses another government agency to do this for them and that costs don't reflect into medicares costs again) If fraud is found they must then either bring charges or sue to collect. (Medicare again uses another Federal agency to do this for them and again this cost is not reflected on medicare) The companies have quality and cost controls they have to look at. (Medicare has the GAO for this and gain the costs of this is not reflected on medicare.

Back up, cowboy. We're talking about Medicare beneficiaries here that use private health insurance plans on Medicare's dime. The Feds pay these companies 115% of what the feds pay Medicare for the beneficiaries that have their claims handled by Medicare directly (whether Medicare outsources paperwork makes no difference since they still manage to get it done for less). There's a premium on the private insurance plans and that premium is getting the axe.