New Baby Cousin born premature... Health Insurance calls it a pre-existing condition and refuses to pay.

[CrimsonWolf]

My new baby cousin was born about a six weeks premature. He's been under neonatal intensive care for about two weeks, and has been doing great. Once they're sure he can be bottle fed ok, the hospital will release him. That's the good news!

Bad news is the insurance company. My aunt and uncle were told to add him within 30 days after the birth. So, they've done that, but now the insurance company is refusing to pay for the neonatal care because they are saying the premature birth is a pre-existing condition. WTF?

I don't even want to think about how big the bill will be without coverage (which included helicopter transport from a rural hospital to a larger hospital...) I heard all this from my other aunt, so I don't know any more details and it would probably be awkward to ask. The only thing I can think of is that they should have added the "baby" to the plan way before it was born, but that's not what the insurance company told them.

Has anyone heard of this happening or have suggestions of dealing with it?








Locked at OP's request


esquared
Anandtech Senior Moderator

 

[Gooberlx2]

Hopefully, when they call to appeal, the insurance company will have a "duh" moment.

 

[panipoori]

obamacare

 

[Redfraggle]

I'm pregnant now, and I was under the impression that the baby is covered as soon as it's born. I mean, it's essentially being covered now, because insurance covers the pregnancy and birth. That seems sketchy that this happened. Hopefully, they will get that overturned.

 

[sandmanwake]

http://www.youtube.com/watch?v...4&feature=channel_page

 

[Turin39789]

Originally posted by: Gooberlx2
Hopefully, when they call to appeal, the insurance company will have a "duh" moment.

this will happen. New members have a field that needs to be set to show that a preexisting investigation has occurred or that they are not subject to prex. They just need to call in and it should get taken care of.

 

[SirStev0]

http://www.funnyordie.com/vide...nsurance-companies-psa

Everything is fine. Repeat after me. Everything is fine.

 

[Vette73]

Originally posted by: Gooberlx2
Hopefully, when they call to appeal, the insurance company will have a "duh" moment.

Haha... yea cause the insurance company will not make them jump through hoops and BS them in hopes they just pay it.


Naaaa... insurance companies are always looking out for their clients. :laugh:

 

[BurnItDwn]

This is why I hate insurance companies. Something like that should simply be illegal and easily enforceable, however, they will intentionally deny every expensive claim they can get away with by default and then only OK them after making people run through hoops.... complete BS.

 

[RoloMather]

Pregnancy = preexisting condition

Yep. Private insurance is good until you get screwed.

 

[Aharami]

appeal. move it higher up the call chain. write your congressman. send letters to the ins company. keep at it until they pick up coverage

 

[Gooberlx2]

Originally posted by: RoloMather
Pregnancy = preexisting condition

Yep. Private insurance is good until you get screwed.

http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

The above may only apply to group/employer plans. Regardless, the newly covered child should not fall in to pre-existing categories for someone who is currently covered.

edited for my own inaccuracies.

 

[GagHalfrunt]

Originally posted by: CrimsonWolf


Has anyone heard of this happening or have suggestions of dealing with it?

Call the crusading reporter that gets 2 minutes a night on the local news. They live for stories like that.

 

[zerocool84]

Originally posted by: BurnItDwn
This is why I hate insurance companies. Something like that should simply be illegal and easily enforceable, however, they will intentionally deny every expensive claim they can get away with by default and then only OK them after making people run through hoops.... complete BS.

Yep I've had to deal with this crap with my mom. It's so stupid. We seriously need health care reform in this country cus the only people it doesn't affect is rich people and us normal people get denied for stupid reasons and get stuck with thousands and thousands in debt from insurance you've been paying into your whole life.

 

[daw123]

Insurance companies are t*ssers.

 

[AstroManLuca]

Originally posted by: GagHalfrunt

Originally posted by: CrimsonWolf


Has anyone heard of this happening or have suggestions of dealing with it?

Call the crusading reporter that gets 2 minutes a night on the local news. They live for stories like that.

Agreed. With all the hubbub over insurance reform and pre-existing conditions these days, they'd eat that shit up. Contact all your local news organizations and see if one wants to pick up your story.

 

[fleabag]

Originally posted by: zerocool84

Originally posted by: BurnItDwn
This is why I hate insurance companies. Something like that should simply be illegal and easily enforceable, however, they will intentionally deny every expensive claim they can get away with by default and then only OK them after making people run through hoops.... complete BS.

Yep I've had to deal with this crap with my mom. It's so stupid. We seriously need health care reform in this country cus the only people it doesn't affect is rich people and us normal people get denied for stupid reasons and get stuck with thousands and thousands in debt from insurance you've been paying into your whole life.

I'm sure you love having examples like this as your battle cry. So what you think the solution is to have government subsidized insurance or some crap?

 

[mugs]

Originally posted by: zerocool84

Originally posted by: BurnItDwn
This is why I hate insurance companies. Something like that should simply be illegal and easily enforceable, however, they will intentionally deny every expensive claim they can get away with by default and then only OK them after making people run through hoops.... complete BS.

Yep I've had to deal with this crap with my mom. It's so stupid. We seriously need health care reform in this country cus the only people it doesn't affect is rich people and us normal people get denied for stupid reasons and get stuck with thousands and thousands in debt from insurance you've been paying into your whole life.

It affects the rich the same as everyone else, but the rich actually have the money to pay the bills.

 

[BurnItDwn]

Originally posted by: AstroManLuca

Originally posted by: GagHalfrunt

Originally posted by: CrimsonWolf


Has anyone heard of this happening or have suggestions of dealing with it?

Call the crusading reporter that gets 2 minutes a night on the local news. They live for stories like that.

Agreed. With all the hubbub over insurance reform and pre-existing conditions these days, they'd eat that shit up. Contact all your local news organizations and see if one wants to pick up your story.

They probably wouldn't report it, after all, insurance companies give them money to advertise, and they wouldn't want to risk loosing any of their precious ad revenue.

 

[aigomorla]

Originally posted by: zerocool84
We seriously need health care reform in this country cus the only people it doesn't affect is rich people and us normal people get denied for stupid reasons and get stuck with thousands and thousands in debt from insurance you've been paying into your whole life.

how does it not effect the rich?

Its because to the rich when this problem arises, they just bust out a check and say how much....

But the rich have the same issues anyone has.

Medical Insurance Companies dont care if ur rich or poor.
They only care if your paying your premiums or not.

And most employee medical plans have far better coverage then a individual rich person's plan.

Talk to your plan advisor. Im sure you were given one.
Have him bring out the original contract and see if it has a condition for pregancy.
If it says in bold letters that it will or will not cover, then your screwed.

This is always why u get everything in writting from an INS company, or you find the documentation that states what the INS company says.

Otherwise when it comes to the commissioner, he's gonna only look at whats in writting, what was signed, and base his judgement off that.

He wont care if your poor, or you dont have the means to survive, only what u signed and agree'd too, will be used in front of a commisioner.

 

[ryan256]

1. Elevate this within the insurance company. Talk to the manager and then his supervisor.
2. Get EVERYTHING in writing. Its alot harder to say things were not communicated clearly when its in black & white.
3. Start seeing of there are any good attorney's in your area. No not the damn ambulance chasers but a real attorney.

 

[CrimsonWolf]

Thank you everybody for the comments and suggestions. :laugh: at the videos and getting the local news involved.

I'll let you all know if something fun and exciting happens.

In the meantime, I know this is a timely issue and all, but...

<======= for P & N please

 

[techs]

Interesting.
Several years ago we actually had a sit down to discuss this type of issue at the insurance company I worked for.

What prompted it was the push to have babies declared as human beings or rather "persons" under the law, which was being promoted by anti-abortion activists.

Since for the entire history of the US unborn babies have never been considered person legally, or pretty much otherwise, the issue of what would happen if they were granted person status and how would that affect our insurance company was important.

Somebody then brought up the fact that if they were not "persons" while in the womb they were not technically covered as persons until the moment of birth.
As such they then would be covered under a family health insurance plan. And the question was raised that since they might have a lifelong medical problem at birth could they be denied under the pre-existing conditions clause.

This is actually a pretty big issue for health insurers since a child with certain illnesses can be reasonably expected to cost millions to the health insurance company. So some argued the health insurance company had a "responsiblity" to question whether they should cover the newborn..


Yep. If you ever worked in health insurance you are pretty shocked at how shocked people are when the find out that you are literally out to screw them out of their life, for money.

 

[Engineer]

Originally posted by: RoloMather
Pregnancy = preexisting condition

Yep. Private insurance is good until you get screwed.

More like good until you try to "really" use it (for something other than a simple office visit). Fuck the insurance companies.

 

[zinfamous]

Originally posted by: panipoori
obamacare

lulznotevenclose.