Texas Blue Cross reverses coverage decision on infant with 'pre-existing condition'

The glare of the national spotlight was too much for Blue Cross Blue Shield of Texas, which reversed its decision not to provide health insurance for a newborn--the so-called "Crowley baby"--after initially denying coverage because the infant required surgery for a heart defect (i.e., a pre-existing condition), reports the Star-Telegram.

The self-employed parents, Doug and Kim Tracy, had called the insurer to obtain coverage before the baby's birth, but were told they had 30 days following the birth to apply for a policy. When the baby subsequently was born with the defect, Blue Cross denied coverage. Friends used Facebook and other media outlets to publicize the denial and gain national media exposure.

Last week, the plan looked into backdating coverage through the Texas Health Insurance Risk Pool. When that didn't work out, plan President Darren Rodgers offered to work with the hospital to pay for the baby's medical care. But this week Blue Cross went a step further, sending the family a letter by courier stating that it agreed to pay the baby's medical expenses from his March 15 birth through March 26, when risk-pool coverage took effect. The surgery to repair the heart defect occurred on March 19.

To learn more:
- read the Star-Telegram article

Suggested Articles

Oscar Health will appeal a judge’s decision to toss its lawsuit against Blue Cross and Blue Shield of Florida over insurance broker agreements.

Physician-led ACOs generated nearly seven times more savings in 2018 than ACOs led by hospitals, a new analysis finds.

Most healthcare organizations are lagging in awareness and preparedness for compliance with proposed interoperability rules, according to a survey.