SMILES

My wife and I know that our baby, due in August, is going o have a BLCL and BLCP. We currently get insurance through her work, but given the situation @ hand she will be quitting her job and we were going to take out an new policy once the baby comes.

We are having alot of trouble with this, as far a pre-existing condition. Has anyone on here been in this situation? What can we do...or is there anything we can do. Basically what we have been told is that if she quits, the baby is unsurable or will have an extremely high premium (1 quote was 3K a month).

We can do cobra for the baby for a maximum of 18 months after she is off maternity leave. Thoughts???

I'm not much help as far as insurance goes but I do have a question as to why your wife is quitting her job. Cleft babies really aren't as fragile as everyone wants to think. She will be home for 6 weeks with the baby which is plenty of time to get accustomed to his or her condition. I thought that I would have to quit my job as well to care for my son, but it just wasn't necessary. If that's what she wants to do is stay home with her children, then more power to her. But I do want to make sure that you know it's not necessary to care for the baby 24-7. They get used to their conditions quickly. And having the insurance would be really helpful. That's just my opinion, though. Good luck with whatever you decide. Heather

This is going to be our 3rd, with our oldest just going to pre-school next year (he will be 5 Nov 1). She wants to be @ home, and daycare is crazy expensive. We had planned on her staying home shortly after she got pregnant. But now that the baby will basically always have this pre-existing condition...insurance for her will be either denied for her or premiums so high that I may as well pay out of pocket for her until she is deemed "fixed" as several insurance companies have put it.

My frustration lies within the fact that our only options are cobra through her work, which is very expensive as well or Medicaid through the state which I really do not want to do. This is why I was wondering if anybody else had been in a similar situation?

I would think it wouldn't be a preexisting condition until the baby is born. You can't have a preexisting condition on someone that isn't here, right? We almost went through that. I would suggest getting a new policy before the baby is born. They won't cover the birth just use the main insurance for that. Plus if you do, do it that way, they would cover if there was anything else wrong that you didn't know about why not the cleft too. It's worth it to dish the extra money out now on an extra policy than take the chance of not having the baby insured. I wouldn't tell them about the cleft, they document everything. Plus you can't prove anything about the baby until it's born. Dr's. have been wrong.

That's what we thought as well....we have called a number of times to different companies. We would be willing...100% to double pay, and take out another policy right now so the baby would be covered, but have been told once there is documentation of a "POSSIBLE" Cl and/or CP that I premiums would be higher, and for some a "clause would be in to not cover the CL/CP if there is one".

I am in disbelief myself. Nothing is 100%. She may come out fine, and she may come out way worse then we know @ this point in time. This has been very frustrating.

When the one guy told me wife "well when your baby is fixed she would be elgible to be put on your policy"....I wanted to reach through the phone and beat him till he showed some respect.

I have to admit that I would probably stay at home as well. I have three children of my own, the last one cleft, and I work full-time. This is only because I have to being a single mom. I know that it is sort of embarrassing to be using public aid, but I myself had to do it. My insurance through work only covered so much and I was divorced so my ex wasn't willing to pay the remaining. So my only choice was to have Medicaid as my second insurance. It was definitely a savior for me, considering the situation I was in. We all pay into it our entire lives. There's no shame in having to use it in a tough situation. Don't be too prideful. There are millions of people abusing the system everyday. Your situation is worthy of the help. And as I said before, St. Louis Children's has programs that can help you pay for surgeries. Check them out. I think you'll be very happy with them. Heather

When I had Dino that state send me information with help for child with birth defects. We didn't use it b/c we wouldn't have qualified for it. CL/CP isn't a cosmetic thing. I can't believe that they would put a clause about that. I tried to search the Internet about preexisting condition on newborns, I couldn't find anything. I did find out that alot of states will not allow pregnancy as a preexisting condition. Well don't worry there is help out there. Drs will work with you on payment & organizations will help children get the help they need. I don't know your money situation, but we are big supporters of The Smile Train. They might be able to send you in the right direction.

Whew! What a crazy situation! Insurance companies can really be a pain! When Jackson was born, I was already staying at home with my 2 year old, but would have probably have had to quit anyway. It would have been very tough to put him in daycare with all of the feeding issues and such. It sounds like your best option may be the Medicaid. It would at least cover most of you expenses. There is also another group called CCA Kids that can help out. Does your state have a state funded program that is just for kids? I know we have a program here in Alabama called Allkids that would help in your situation. It is provided through our local blue cross, and covers everything, including routine care 100%. Sorry I can't be of more help!
Allison

What about trying the "temporary condition" approach? I know the insurance company is calling it preexisting, but it will only be a condition until it is corrected. Its worth a shot. But it does sound like your best bet is to go with the public aid. My father is in insurance and I asked him about your situation. He said that you need to file a complaint with the insurance company. Basically find someone as high up the ladder as you can get and then ask for their boss.

Ohio has BCMH which pays for any and all bills that insurance doesn't pay for. I think it will also pay for people's medical bills that don't have insurance. It will only pay for my child's problems that have to do with the cleft lip or palate such as; any and all surgeries, teeth & gum work, and ear problems. I would check to see if they have that in your state. BCMH stands for Bureau of Children's Medical handicaps, I think.