Texas Family Denied Health Insurance for Newborn with Rare Birth Defect
Houston Tracy was not even alive for one week when he had life-saving open heart surgery for a rare birth defect called d-transposition of the great arteries on March 19th. On March 24th, the Tracy family learned that their son would not be covered by Blue Cross Blue Shield of Texas insurance because of the “pre-existing condition”.
It turns out, the term pre-existing condition can apply the moment someone is born.
The Tracy’s are small business owners who do not carry insurance on themselves due to the cost, but purchase individual insurance plans for their children. Doug Tracy says that he followed all of the appropriate procedures to ensure Houston would have coverage starting the day of his birth. However, he was not able to obtain that insurance at the time.
Margaret Jarvis, senior manager of media and public relations at BCBS TX says in a statement, “For children whose parents are not BCBSTX members, who want child-only coverage, we offer individual policies, beginning at the age of 60 days," wrote Jarvis. "BCBSTX has spoken with the father of this child, and we are exploring all available alternative coverage options."
The “great arteries” refer to the Aorta and the Pulmonary Artery, the two major arteries that carry blood away from the heart. In the case of d-Transposition of the Great Arteries, the vessels are attached from the wrong ventricle: the aorta arises from the right when it is supposed to arise from the left.
This creates a situation where oxygen-poor blood returning from the body to the right side of the heart is pumped back out to the body through the aorta and never reaches the lungs for oxygenation. Oxygen-rich blood from the lungs is pumped into the left side of the heart and then returned back to the lungs. Unless there is some place in the circulation where the oxygenated and non-oxygenated bloods can mix, all of the organs of the body become deprived of oxygen.
Kim Tracy describes her prenatal care and screenings as “perfect” – they never knew anything was wrong before Houston was born. Transposition is almost always diagnosed in the first hours or days of life due to cyanosis (blue color) or rapid breathing in response to the low oxygen levels. The cause is unknown, but genetic factors may contribute. Pregnant mothers with uncontrolled diabetes are at a higher risk of having children with transposition.
If untreated, over 50% of infants will die in the first month of life, and 90% in the first year.
The surgery to correct transposition is called an arterial switch operation. This involves cutting off the aorta and the pulmonary artery just above the point where they leave the heart and reconnecting them to the proper ventricle. Since the coronary arteries must stay with the aorta, they must be taken and reimplanted as well. Any other heart defect, such as a ventricular septal defect or atrial septal defect are repaired at the same time.
Over the last few decades, the survival of children with Transposition has improved dramatically. When there are no unusual risk factors, over 95% of infants have a successful surgery. Long-term cardiac function should be excellent for most children, including little Houston, but routine evaluation will be required for the rest of life.
One of the provisions of the new health care reform act prohibits insurance companies from denying coverage to children with a pre-existing condition, but the law will not likely take effect for at least another six months.
Doug Tracy said his family has found an alternative route to get his child coverage through the Texas Health Insurance Risk Pool, and the policy will only cost $277 a month -- $10 more than the premium on the policy he tried to take out for his son.