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RE: I've had it with insurance companies - 12/7/2009 10:59:40 AM

CallaFirestormBW

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quote:

ORIGINAL: NeedToUseYou

I'm pretty sure this is a paperwork mix up of some sort, as most insurance Medical insurance policies cover newborns, as long as you register them with 30 days of birth. A pre-existing condition is an impossibilty with a newborn, seeing the coverage is applied at the instant of birth. You just have to inform the insurer within the proper time frame.

Sorry, Need,
This is unlikely to be a paperwork mixup. We've had a number of cases down here in Texas now (and a few more across the country, from what I've heard), of newborns being denied coverage because they were (1) too large at birth [>75th percentile of weight], (2) to SMALL at birth [<40th percentile in weight], (3) the parents or an immediate family member had a medical condition that could be considered 'hereditary', whether or not the parents were diagnosed with the condition or were currently getting treatment for it and regardless of whether the baby had any indications that xhe would even HAVE the condition, or the newborn slipped off the "median scale" for health as determined by birth and 3 minute APGAR scores, meconium evacuation prior to birth, or recorded 'fetal distress' during labor.

We are in a sad, sad state, folks, and far too many people seem to think that burying their head in the sands and pretending that things can continue as status quo will be fine... but there IS no status quo, because every time we, as consumers, are pushed back behind a new line to increase profits, the discussions are already under way about what the NEXT line is going to be.

I work in the industry, and I see this stuff -every- single day, and I find it completely appalling that we, as a nation, allow this to continue, and that a large portion of our population actually DEFEND it.

Calla

< Message edited by CallaFirestormBW -- 12/7/2009 11:01:06 AM >

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Post #: 41

RE: I've had it with insurance companies - 12/7/2009 11:11:31 AM

Mercnbeth

Posts: 11766
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Wow - A new baby born 3 days ago with a heart murmur and your course of action is to come to a BDSM site and ask for help from the perverted 'experts'!

That represents dedication to a cause!

quote:

I doubt anyone knows what is on their medical file from their birth. As of this date, I have never has any Doctor tell me I ever had a heart murmur and it is probability the the same birthing thing as happens to most children in this world, which is why they check several times now before they actually put it in the file.

It speaks volumes that somehow, apparently in less than 3 days, an insurance company was able to check your specific policy and look into your personal history and make a instantaneous decision of non-coverage even before they got the bill from the hospital! Amazing since you say that you never had your murmur diagnosed by a physician. The insurance company went back to your birth, 49 years ago, and discovered you too had, as an newborn, a reported heart murmur?

I'd like to know what insurance company went back and computerized all the birth records from a half century ago just to have them ready in case someone, someday, had a baby with a heart murmur so they can disqualify them from coverage. You think once the national health care bill goes through that the government will have those same records at their fingertips, considering now they routinely lose, or can't get a copy of many records, about stuff that happened only a few years ago, requested in months?

I hope when they take over the coverage - they'll also take over the record keeping if they can do things like you report. Maybe that's how all that Medicaid fraud will be addressed.

< Message edited by Mercnbeth -- 12/7/2009 11:42:06 AM >

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Post #: 42

RE: I've had it with insurance companies - 12/7/2009 11:31:45 AM

pahunkboy

Posts: 33061
Joined: 2/26/2006
From: Central Pennsylvania
Status: offline

Hey now!!

I have gotten some great advice from this site.

-- I agree that health reform is going to be bad. I don't want govt to fix anymore problems. They actaully phoned Jenny to come in and get an h1n1 shot. The kicker is- that same office already gave her the shot.
Then I heard a commercial to come on in for a h1n1 shot.

But this is a hijack- the health care reform is- we have ample thread on that already.

Anyhow- I think this crowd here is pretty smart. I have gotten good advice. I did not really even mean to stay this long- but I do because of the cool people.

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Post #: 43

RE: I've had it with insurance companies - 12/7/2009 3:20:29 PM

NeedToUseYou

Posts: 2297
Joined: 12/24/2005
From: None of your business
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quote:

ORIGINAL: CallaFirestormBW

quote:

ORIGINAL: NeedToUseYou

I'm pretty sure this is a paperwork mix up of some sort, as most insurance Medical insurance policies cover newborns, as long as you register them with 30 days of birth. A pre-existing condition is an impossibilty with a newborn, seeing the coverage is applied at the instant of birth. You just have to inform the insurer within the proper time frame.

Sorry, Need,
This is unlikely to be a paperwork mixup. We've had a number of cases down here in Texas now (and a few more across the country, from what I've heard), of newborns being denied coverage because they were (1) too large at birth [>75th percentile of weight], (2) to SMALL at birth [<40th percentile in weight], (3) the parents or an immediate family member had a medical condition that could be considered 'hereditary', whether or not the parents were diagnosed with the condition or were currently getting treatment for it and regardless of whether the baby had any indications that xhe would even HAVE the condition, or the newborn slipped off the "median scale" for health as determined by birth and 3 minute APGAR scores, meconium evacuation prior to birth, or recorded 'fetal distress' during labor.

We are in a sad, sad state, folks, and far too many people seem to think that burying their head in the sands and pretending that things can continue as status quo will be fine... but there IS no status quo, because every time we, as consumers, are pushed back behind a new line to increase profits, the discussions are already under way about what the NEXT line is going to be.

I work in the industry, and I see this stuff -every- single day, and I find it completely appalling that we, as a nation, allow this to continue, and that a large portion of our population actually DEFEND it.

Calla

This is in IL. this link states the law in regards to newborns in IL.

http://www.insurance.illinois.gov/HealthInsurance/newborn.asp

Essentially, a newborn can 100% of the time be added to a valid policyholders coverage regardless of illness, or anything whatsoever.

Most of what you said would not apply, like I said, I believe(99%, sure really) this case has nothing to do with the transfer of coverage to the newborn, rather it is a case of disputed validity of the parents coverage, and thus there would potentially be no valid coverage to apply to the baby.

So, the "clearing" up is about the parent, not the baby.

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Post #: 44

RE: I've had it with insurance companies - 12/7/2009 3:53:31 PM

Termyn8or

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Joined: 11/12/2005
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FR

Nobody seems to be able to address the issue of them not knowing about this when they were cashing those premium checks.

If I get car insurance and lie, and they find out they will send me a cancellation notice and a refund.

T

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Post #: 45

RE: I've had it with insurance companies - 12/7/2009 4:13:05 PM

LadyEllen

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Joined: 6/30/2006
From: Stourport-England
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The policy holder is under a duty to inform the insurer of all circumstances of which he is aware. Meanwhile the policy holder can be shown not to have been aware of the information the insurer is seeking to rely on as not having been disclosed. If the information can also/ alternatively be shown to have been false, or falsely relied on by the insurer then the insurer has no choice other than to settle the claim out of court or settle it at court. The insurer holding out in this way indicates they will need to be pushed before they will fall.

E

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Post #: 46

RE: I've had it with insurance companies - 12/7/2009 5:26:45 PM

Termyn8or

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That's not my point. The original idea of insurance was to share risk. To share risk, everyone gets involved.

Now it seems they just want the money. Any excuse to deny coverage, it's all in the fine print. The way I see it, those who need the insurance the most are the exact ones who get denied. You have a sportscar ? no coverage on it unless you pay through the nose. Old ? no life insurance for you then. Likewise if you fall ill, no medical insurance.

Insurance is by definition basically selective socialism. It has fueled countless price bubbles because everybody wants into that deep pocket. And no matter how much you pay these fucks they always want more. Doctors in Ohio at one time were the highest paid in the country. Yet there was still fraud. OK, maybe the fraud accounts for part of that windfall, but the facts remain.

Another fact that still remains is that you rarely if ever hear of an insurance company losing money in any given quarter. How can this be if they've been burdened with fraudulent claims and saddled with covering losses ? Like true socialism, insurance is NOT supposed to be a gold mine for those who administrate it. However human nature seems to prevail, greed especially.

I don't claim to have the answer, nor do I even suppose there is an answer. But the way it's handled now is certainly not the right way.

Why do you think people who make $80,000 a year or more don't get married and put their olady on welfare ? Mainly for medical coverage that will pretty much never be denied.

So the best solution is to burn your degree, quit your job and go on the public dole. Quite logical for alot of people. There are alot of different sets of circumstances out there, and for some this works just fine. More than you think.

Others do have ethics and won't take that path, but then what is so unethical about it ? Even if you got your money well hidden (mine is right under my philosopher's stone) you are still paying alot in taxes. And don't gimme that 'well these taxes are for this and those taxes are for that' crap. Over here they throw all the money in a big pot and once they have their pockets stuffed with it whatever is left is used for the public good. Things like the arts, tunnels for squirrels and all sorts of important shit. But they don't seem to be able to build a road or bridge here that doesn't have to be torn up every few months. But I don't want to get started on that.

I am totally against insurance, the only thing worse would be to let our government handle it.

T

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Post #: 47

RE: I've had it with insurance companies - 12/7/2009 10:20:34 PM

LafayetteLady

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Joined: 5/2/2007
From: Northern New Jersey
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quote:

ORIGINAL: Mercnbeth

Wow - A new baby born 3 days ago with a heart murmur and your course of action is to come to a BDSM site and ask for help from the perverted 'experts'!

I honestly don't believe that the OP came here looking for advice. He really seems to have everything under control and is doing everything that needs to be done.

More a matter of venting. We all need to blow off steam somewhere. Insurance companies ARE getting out of control. The recent reports of one infant being denied coverage because they were in the 95 percentile and the insurer claimed obesity, and the other 2 year old denied coverage because she was less than the 50 percentile, although completely healthy other than being late to speak (I believe that it was speaking. I do recall it being something innocuous). My insurance company denied coverage for the most popular prescription cough medicine. They deny it for anyone over 21 and can't explain why other than that is what the "formulary" says.

Point is we all need to blow off steam. Sometimes even when we are doing all that we can and should be doing, we like to have the support of others. It can be comforting even to see 4 pages of posts from people saying "you are right, your insurance company is treating you like crap." And let's not forget that for many that parental instinct of protecting your "cub" can be pretty strong.

To the OP, Congratulations on the new addition. Everything will work out in the end. Try not to stress too much that you are not able to enjoy her to the fullest.

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Post #: 48

RE: I've had it with insurance companies - 12/8/2009 7:45:42 AM

Termyn8or

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FR

Just thought I would throw this out there. I know someone who was born with a heart murmer, she is now well into her seventies, almost eighty. Other than a mild stroke a few years ago she has had a couple of back problems (she worked) and three childbirths. None of these things were caused by a by heart murmer.

T

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Post #: 49