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Baby and private insurance...

SJBride05SJBride05
in Northern California Babies

Kind of a weird question, but I can't shake it...

When applying for private insurance after the baby is born, could the baby get denied coverage?  I know I was denied because of "pre-existing condition" a couple of years ago.  Was wondering if the same thing could happen to a newborn. 

I have this huge fear that if something is wrong at birth (god-forbid!) and we apply for private insurance,  the baby may get denied because of the extra care it needs at birth.

May be a totally irrational fear, but I needed to ask...

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Re: Baby and private insurance...

  • Dragonfly_BrideDragonfly_Bride member
    Weird, I was just thinking about this last night. I'm looking forward to finding out the answer...
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  • My.ABC.LifeMy.ABC.Life
    Maybe muffinhead will jump in here... but I'm 99% sure that her 2nd DS was denied coverage after a (now, non-existent) condition was discovered in-utero.  Probably not what you were looking to hear.
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  • RevJGRevJG
    Technically yes, I think a baby could be denied for a pre-existing condition. However, thanks to recent health care reform, I would think the baby would be eligible for a PCIP (pre-existing condition insurance plan).  The White House has a website up (www.healthcare.gov) that does a decent job of explaining the new legislation. 
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  • Lesley423Lesley423
    Technically, yes.  But since you have Kaiser and you're applying for Kaiser for your little one, I'm guessing you are probably fine.  L was diagnosed with hydronephrosis while in utero and he still had it after he was born.  Immediately after he was born a specialist came to see him (he was in the delivery room) and they evaluated him.  They elected to keep him in the hospital for at least 48 hours.  I applied for coverage for him and he wasn't denied.  I'm thinking part of the reason is because Kaiser knew his medical history already.
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  • StefandToddStefandTodd member

    imageRevJG:
    Technically yes, I think a baby could be denied for a pre-existing condition. However, thanks to recent health care reform, I would think the baby would be eligible for a PCIP (pre-existing condition insurance plan).  The White House has a website up (www.healthcare.gov) that does a decent job of explaining the new legislation. 

    I was thinking of this!  I think I heard that the new legislation for pre-existing conditions is actually going into effect now, so you very well might be okay (hooray for health care reform!! ...IMO) :)

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  • I<3MYHUSBANDI<3MYHUSBAND
    imageStefandTodd:

    imageRevJG:
    Technically yes, I think a baby could be denied for a pre-existing condition. However, thanks to recent health care reform, I would think the baby would be eligible for a PCIP (pre-existing condition insurance plan).  The White House has a website up (www.healthcare.gov) that does a decent job of explaining the new legislation. 

    I was thinking of this!  I think I heard that the new legislation for pre-existing conditions is actually going into effect now, so you very well might be okay (hooray for health care reform!! ...IMO) :)

    I think before yes, I think now after the reform no. However they still may be able to charge you an arm and a leg for the cost, that I am not sure of.

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  • futrkingsleyfutrkingsley member

    Unfortunately, this is a grey area.  The health reform law that passed in April says that plans can't have pre-existing condition exclusions for children as of six months later (which is approximately now).  What that means in reality isn't totally clear.  In California, there is not a guarantee that an individual CAN purchase insurance -- companies are allowed to deny applications for coverage.  The new law doesn't prohibit that until 2014.  So in our state, you could apply for coverage and be denied.  But if you are approved, whatever condition the child had would have to be covered fully with no limits.  However, the insurance company is still allowed to charge whatever they want for that policy so there is no guarantee that that policy would be affordable.

    Here's a link to the source I used (which is published by my employer): https://www.kff.org/healthreform/upload/8061.pdf. I did a quick search for pre-existing condition.

    You should have a conversation with a KP individual policy sales rep to sketch out your plan to make sure it will work as you want because on the off chance something isn't perfect, you will only have 30 days to sign up your child for your employers' plan (for which they of course couldn't be denied). That will also give you time to figure out if it is in fact cheaper than your current plan.

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  • kittylovekittylove member
    Sadly yes. We have been denied coverage for Riley twice through private insurance. Once from Kaiser and a second time from Blue Cross. Blue Cross denied him at birth because he was a "pre-term" birth (36w2d), even though he needed no nicu, and even roomed in with me.
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