Newborn with Birth Defect Denied Coverage

(CBS)  For newborn Houston Tracy, the historic health care overhaul came too late.

Houston, born March 15 at a Texas hospital, suffers from a defect in his arteries. When his parents, Doug and Kim, applied to have his corrective surgery covered under their insurance, they were denied, with their carrier claiming Houston had a pre-existing condition, reports CBS station KTVT.

The Tracys are fighting the decision by Blue Cross and Blue Shield of Texas.

"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," Doug Tracy said. "If it's mandated that everyone have health insurance, than how can one be denied?"

Legislation passed this week by Congress and signed by President Obama that would end the practice of denying coverage to patients with pre-existing conditions does not go into effect until September.

The congenital heart defect causes the two major vessels that carry blood away from the heart to become switched.

"He was born with what's called transposition of the great arteries," Doug Tracy said. "It's heart wrenching; I hated it."

The Tracy's are both small business owners and do not carry health insurance for themselves. They do carry insurance on their two other children and tried to get insurance for Houston, but they found out Wednesday his coverage was denied.

The health care provider declined to comment specifically on the Tracys' case, and released this statement to KTVT:

"We will work closely with our customers to keep them informed of any changes that may result from the new law. We will continue to review the bill's requirements on our business and their respective time frames to ensure full compliance."

The Forth Worth Star-Telegram received this explanation from Blue Cross Blue Shield of Texas:

Our policy is that if a family has existing coverage with us, a baby can be added to the contract within 31 days without the need for underwriting to assess the baby's eligibility."

The condition Houston has is rarely detected before birth.

"My whole pregnancy was simple, it was easy, no complications, doctor visits were great," Houston's mother, Kim Tracy, said. "Perfect sonograms, great little pictures and then, he wasn't perfect."

Houston had life-saving surgery at Cook's Children's Medical Center in Fort Worth shortly after being born.

"He's doing really good," his mother said with a smile. "he's a little tough guy."

Local Video from CBS 11 / TXA 21 in Dallas/Fort Worth

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[FauxNews]

This is biased reporting against the insurance company. Even though Blue Cross Blue Shield is a lousy company that rips off thousands of people daily, they are not at fault on this one. If CBS had any investigative reporters left, they could easily find examples of BCBS not paying promised benefits.

[ge556]

It seems like most of the commentors here don't understand insurance. You don't wait until something goes wrong, and then get insurance to pay for it. That's what these parents tried to do.
Now, with universal health care, this won't happen, but it means that everyone has to pay to buy in, rather than gamble that they won't need it.

[smoknmirrors]

I quit using BCBS 50 years ago. That's tens of thousands of dollars in premiums they haven't received from my family. I see they haven't changed. I haven't missed a night's sleep. If UHC drives them out of business, I won't miss a night's sleep then either.

[First-Lady-Love]

Maybe I don't know the whole story here but didn't the parents put the baby on the insurance when he was first born. Every insurance company gives you 30 days to put your newborn on the insurance, if these parents thought there was something wrong with their child from the day he was born, why would they wait a month after he was born to put the child on the insurance. Wasn't this child born about 2 weeks ago, so BCBS of TX should cover the operation because the parents had 30 days to put their child on the insurance.

[avigil2]

These insurance companies are absolutely despicable.

[3684doug]

To all of those that seem to think the insurance company is right in this, please also consider that BCBS took out the first months premium in a bank draft from the Tracy's account. Then a week later made the decision to deny coverage to this baby. How is any part of the actions of Blue Cross Blue Shield right?!

[BigCatOne]

I don't see any Republican posters shouting 'Baby Killer!' This is why I loathe Republicans.

[kbbach]

pure greed this is why we neede an overhaul. I was with a friend when his son died because the insurance company he had canceled his policy and left him no way to pay for the opperations his son needed.and the doctors refused to do anything with out a lot of money down.greedy s. o.bs should be forced to cover all people no mater what

[Calendular]

In this type of situation, probably insurance companies could generate a lot of sincere corporate goodwill by cutting red tape to provide coverage.

[james22125]

Agree, but the fact that they choose to use this tactic tells you something about their priorities.

[flsunjnky]

This is a fine example of why we need a health care bill. And, this kind of thing could happen to anyone, even a Republican.

[californiadreaming]

I don't believe there is anything in the health care bill that would prevent this kind of thing. That's why they needed to change the system to prevent things like this from happening. Most of that bill just extends coverage and does nothing to reform insurers.

[james22125]

Not "could", in my family it "has". And more than once. Yes, even to Republicans.

[Ron-in-Siberia]

The insurers response seems reasonable, given current law. The condition is clearly pre-existing. This is why President Obama's initiative is needed. Health insurers will be barred from refusing to cover pre-existing conditions once the provisions of the bill become law.

[KeithDrippingSprings]

Why should we need laws for companies to do the right thing. Insurance implies that the very existence of the company is dependent on helping people that need help and spreading the cost to all so the burden is less on us all. .

[mollydtt]

Denying care and denying insurance is the true "death panel". I realize that republicans feel that enough people already had insurance, and the rest just didn't deserve to receive insurance, because it will be too expensive, but isn't this a "death panel"?