Health insurance company Aetna, held up paying thousands of dollars in medical charges to newborn Kinsleigh Barnes, according to a report by ABC News. The reason? The insurance company said the newborn might have been suffering from a pre-existing condition.

New mother Kelly Barnes is heartbroken and angry. 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.”

According to Barnes’ attorney, “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. And in this case, of course, that would be real hard, given the fact the baby was still in the womb.”

Aetna later apologized and said the mistake was a coding error. Yet, consumer expert Deann Friedholm asserts that what the Barnes family experienced is not uncommon.

“It really might be a clerical error, but let’s face it, it is in the company’s interest to not pay bills. The fewer bills they pay, the better their bottom line is,” Friedholm said.

Read the full story, “Newborn Baby with Pre-Existing Condition”.

Newborn Baby With Pre-Existing Condition? Baby Denied Healthcare While in the Womb.
Insurance Company Says Baby’s Medical Claims Were Held Up by Coding Error, Not Pre-Existing Condition As Mom Was Told.

Oct. 15, 2010

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.

“I don’t know how something could be pre-existing in a baby, so it was very shocking to me to see something like that,” Barnes told “Good Morning America.” “It’s a slap in the face. Her medical bills are the last thing I should be worrying about. I should know that my baby is being taken care of.”

“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.”

Finally, Barnes contacted “GMA.” We called the insurance company in September and they claim that the pre-existing condition hold up was a simple coding error and have been paying back Barnes’ claims since July. But Barnes said that no one ever told her that and it wasn’t until “GMA” got involved that all the costs were finally paid this week.

“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.”

Consumer expert Deann Friedholm said what Barnes experienced is not uncommon.

“It really might be a clerical error, but let’s face it, it is in the company’s interest to not pay bills. The fewer bills they pay, the better their bottom line is,” Friedholm said.

Kinsleigh still needs heart operations, but those Aetna said they’ll be paying for. Even so, Barnes said she’ll never forget the nightmare that Aetna put her and her family through.

Following the “GMA” investigation, Aetna apologized to Barnes.

Tips for the Insured

The following tips were provided by Deborah Senn, former Insurance Commissioner for the State of Washington and author of an upcoming book called “Survival Insurance.”

  1. Look at your Explanation of Benefits form very carefully.
  2. Question everything and if it doesn’t look right, ask.
  3. If you have to challenge the companies, don’t stop fighting.
  4. When you talk to the insurance company, try to do it online. That way, you can get a record of the conversation online. This can be really helpful.

UPDATE

After ABC News aired a report about a woman who claimed her insurance company, Aetna, denied her newborn baby coverage due to a pre-existing condition, the company apologized and said the mistake was a simple coding error.

ABC News Gets Answers: Aetna’s Response
Aetna’s Answer to Mother’s Claim

Statement from Aetna:
We’ve apologized to Mrs. Barnes for the coding error and for not notifying her immediately in July when we fixed it. Nonetheless, we have correctly paid numerous claims totaling more than $300,000 for both the baby and Mrs. Barnes, and their hospitals had Aetna’s approval for the care to be covered from the beginning. Mrs. Barnes has never been billed by the hospitals due to our error.

Aetna processes nearly 450 million claims each year, but mistakes do happen and are usually resolved between Aetna, hospitals and doctors.

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