Adventures in American Health Care -Pre-Existing Child

Whatever side you come down on the Health Care issue, my question for you is are you against being able to exclude children because of pre-existing conditions?  Should a family who discovered a year ago their child had cancer be excluded from care for whatever time it is the policy designates.

Recently, we acquired some new health insurance for our family and paid for two older children to be covered as well.  We submitted what we "thought" was the correct paperwork, but the first visit to a doctor for a continuing condition was turned down due to a 180 day pre-existing condition cause.  So we called the company and found out the reason was the proper paperwork had not been submitted.

Not being satisfied there, I questioned this company as to the "why" I was having to call about my child in the first place.  My child is clearly under the limit, 15 years old, and the way the web site from the U.S. Government states it is different from what I was being told.  In fact, what I was being told was the new law did not apply to "this" policy - and could not be told the reason. 

The law is interesting in the way it is written for pre-existing conditions for children.  There have to be certain conditions met.

1. The law went into effect for policies issued on or before March 23, 2010.
2. The "effective date" of the law is September 23, 2010.
3. According to the Government Web site http://www.healthcare.gov/law/provisions/ChildrensPCIP/childrenspcip.html there is something called the "policy year" which is the actual contract date the policy started on for the entire organization if a group plan.  If the plan is an individual plan the "policy year" date is the date the policy was purchased.
4. The Policy Year date is important because the new law does not go into effect until AFTER the policy date.

Example 1:  ABC Corporation buys a policy on June 23, 2010.  Employee A is hire in August 23, 2010.  Employee A has a son with Cancer.  Employee A now has to wait until the policy date of June 23 before coverage is extended.

Example 2: Jenny buys a policy on October 23, 2010.  Jenny has a daughter with Lupus and the insurance company denies the coverage because they say they have a 180 pre-existing condition clause.  Jenny's policy date is October 23, (which is after the September 23 date) so her daughter is covered under the law.

Congress built some really nice loop holes into the coverage for the health insurance companies, didn't they.  I guess part of the 100 plus million salaries some of the CEO's of these companies are making cannot be used for actually covering children.

In our case, our policy date was September 25, 2010.  Since the effective date of the law was September 23, 2010 - this should have made our policy automatically covered without a problem, right?  Not according to the insurance company.  I guess they like to make up and interpret laws for themselves, and so we were told we were responsible for the bills.  Our plan started on October 25, 2010.  Luckily, we somehow "found" form to request a Waiver and provided all of the information we were missing, so this is a mute point for us.  I just wonder how many people out there with children are being denied coverage under the law.

If you get a chance, go and  read the information provided.  If you are a parent with a child and you have an individual plan issued before March 23, 2010 - these plans are excluded. 

Why can't our Congress and Senate just pass a law which is simple and easy to understand?  As we get more and more into the release of this law during the coming time to 2014 when the laws will apply to everyone, I will be interested to see and find the loopholes the Insurance Companies built for themselves.


If we had Universal Health Care, this would not be an issue.  If our government was more scared of the common man than the corporations, this would not be an issue.  For those of you who fought so hard and long for health care to fail, congratulations, you're probably well covered yourself, but you are killing a lot of children in the mean time.  (A friend of mine said he did not believe in "Socialized" medicine.  I asked if he was on Medicare, he said "yes" I informed him Medicare IS socialized medicine and he said he'd never realized this before.)

There is a silver lining to my story.  We found the loophole the insurance company created for itself and have provided the proper paperwork filled out in the proper fashion to the proper people - so our coverage should not be an issue with "should" being the operative word.

Join us next time for "More Adventures in Health Care" as we experience new and interesting ways the insurance companies try to deny claims and coverage.  Boy, am I glad we are in America with the best HealthCare in the world, thank goodness.