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Newborn With Heart Defect Is Denied Insurance Coverage

by Jan Jarvis

At birth, Houston Tracy let out a single loud cry before his father cut the cord and handed him to a nurse.

Instantly, Doug Tracy knew something was wrong with his son.

"He wasn't turning pink fast enough," Tracy said. "When they listened to his chest, they realized he had an issue."

That turned out to be d-transposition of the great arteries, a defect in which the two major vessels that carry blood away from the heart are reversed. The condition causes babies to turn blue.

Surgery would correct it, but within days of Houston's birth March 15, Tracy learned that his application for health insurance to cover his son had been denied. The reason: a pre-existing condition.

"How can he have a pre-existing condition if the baby didn't exist until now?" Tracy asked.

New federal legislation that will prevent insurance companies from denying children coverage based on a pre-existing condition comes too late for the Tracys. The legislation, passed by Congress and signed by President Barack Obama this week, won't go into effect until September.

But Houston, who is hospitalized at Cook Children's Medical Center in Fort Worth, needs coverage now.

Without surgery, babies with this condition often die soon after birth, although some may live as long as a year, said Dr. Steve Muyskens, a pediatric cardiologist.

"In his case, we had to intervene in the first days of life," Muyskens said.

The defect

With this condition, oxygen-rich blood goes back to the lungs and oxygen-poor blood goes back to the body, depriving it of oxygen and damaging the heart muscle. Surgery to move the arteries to their normal position is usually done within three to five days of birth. It basically involves swapping the misplaced arteries.

"It sounds simple, but it's complex because you have to move tiny coronary arteries that in a baby are 1 to 2 millimeters," Muyskens said.

Doug and Kim Tracy, who live in Crowley and are self-employed, carry health insurance on their other two children. They said they cannot afford insurance for themselves.

They paid out of pocket for Kim Tracy's neonatal care and the baby's delivery. Doug Tracy said they were told that they could apply for insurance for Houston within 30 days of his birth.

A spokeswoman for Blue Cross Blue Shield of Texas declined to comment but issued a statement saying, "Our policy is that if a family has existing coverage with us, a baby can be added to the contract within 31 days without the need for underwriting to assess the baby's eligibility."

But that's only if the parents have coverage, said the spokeswoman, Margaret Jarvis. Read that with the emphasis on parents.

Lawmaker tries to help

After being contacted by the Tracy family, state Rep. Chris Turner, D-Arlington, said he asked the Texas Department of Insurance if there are provisions that can be used to help the family. He said he has not received a complete answer.

Virtually everyone can agree that no one should be denied health coverage because of pre-existing conditions, Turner said.

Tracy said he was appealing the insurance company's decision.

A five-hour surgery to correct the defect was performed Friday, and Houston is doing well. He is being fed through a tube and must learn to swallow. But he should be able to go home within a couple of weeks, Tracy said.

"He's such a fighter, and the doctors say he's got a lot of spunk," Tracy said. "The nurses nicknamed him 'Little Rocky.'"

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