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Pre-Existing Conditions Can Begin at the Moment of Birth

By Rachel Stockton

Most of us are aware of the term “pre-existing condition” when it comes to insurance policies; if an individual does not have group medical care through their employment, any type of long term health issue can cause them to, at best, be denied coverage on said condition, and at worst, be denied coverage altogether.

This concept with all of its implications is unfortunately, a fact of life; we all know this.  But what many of us may NOT realize is that the term “pre-existing condition” can begin at the moment of birth.

CBS is reporting a story about a Texas couple who are learning this the hard way.  As small business owners, they do not have coverage for themselves; but for their two young children, they have policies with Blue Cross and Blue Shield of Texas.

When their third child was born, the moments following the birth were not as joyous as they are in most cases.  Doug Tracy, the father of the child, recalls that almost immediately after his son Houston’s birth, he knew something was very wrong.  The baby’s cry was weak, his skin had an unnatural blue pallor, and the doctors became intensely serious.

Houston was born with what is officially termed a “d transposition of the great arteries.”  To simply describe a complex problem, the two major vessels (the primary aorta and pulmonary arteries) that carry blood from the heart are switched.  Because the connections in the heart are incorrect, blood from the left and right side of the heart intermix.  Without an arterial switch procedure performed on an infant with this condition during the first thirty days of life, the baby will die.

Houston’s parents found out that since his problem began in the womb, Blue Cross considered the defect a pre-existing condition, even though it would have been impossible for his parents to have known about it until he drew his first breath.  Houston’s mother had no complications during her pregnancy that would have warranted any kind of diagnostic procedure that could have detected it.

Fortunately, Houston underwent surgery the week he was born; he is expected to live a normal life.  The financial hit to his parents, however, could have been devastating, had they not found some relief through the Texas Health Insurance Risk Pool.

The new health care bill prohibits insurance companies from denying coverage to newborns; however, this provision will not go into effect until September, six months after it was passed.

According to the March of Dimes, 25,000 children are born with heart defects every year in the United States.  While technically these congenital birth defects happen in utero, denying coverage for these infants at the moment of birth can literally mean the difference between life and death.