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Entries in Pre-Existing Condition (1)

Friday
Oct152010

Pre-Existing Condition? Baby Denied Medical Coverage While in Womb

Photo Courtesy - The Barnes Family(NEW YORK) -- New mother Kelly Barnes is heartbroken and angry.

She's heartbroken because she has endured what no mother should have to endure. While pregnant with twins, she lost one of them at 30 weeks. The other baby, Kinsleigh, was born with serious heart problems.

But Barnes is angry because her insurance company, Aetna, held up paying thousands of dollars in medical charges. The reason? The insurance company said the newborn might have been suffering from a pre-existing condition.

"Under Aetna's own definition, in order to deny for pre-existing condition, there has to be medical advice or care that was rendered or given," Barnes' attorney, Tom Caldwell, said. "And in this case, of course, that would be real hard, given the fact the baby was still in the womb."

Barnes said she called Aetna hoping for a resolution.

"It's like you're talking to somebody who is reading from a script," Barnes said. "They don't have answers for you based on what you're telling them."

ABC News called the insurance company in September and it claims the pre-existing condition hold-up was a simple coding error and it wasn't paying back Barnes' claims since July. But Barnes said that no one ever told her that, and it wasn't until ABC got involved that all the costs were finally paid.

"It is my personal belief that they will -- they do this to you, expecting you not to follow up with it," she said. "And I'm sure most people don't."

Kinsleigh still needs heart operations, but those Aetna said it will foot the bill. Even so, Barnes said she'll never forget the nightmare that Aetna put her and her family through.

Following the ABC News investigation, Aetna apologized to Barnes.

Copyright 2010 ABC News Radio







ABC News Radio