Parents of Sick Kids Happy, but Wary as Health Insurance Provisions Kick In

They welcome an end to preexisting condition rule but worry about high premiums.

ByABC News
September 20, 2010, 9:16 PM

WASHINGTON, Sept. 21, 2010 — -- When the Raether triplets were born 10 weeks prematurely, Mira Raether suffered the most serious medical problems. She was diagnosed with renal acidosis and failure to thrive. At 2 1/2 years old, she underwent a kidney transplant.

Now 4 years old, the Milwaukee, Wis., toddler has exhausted the $500,000 lifetime cap on her parents' insurance. She no longer has private coverage for treatment of her kidney problems and currently has temporary Medicare coverage.

"They [the insurance company] won't pay the claims," said her mother, Sheryl Raether.

That will change Wednesday as the first changes under the new health care law begin.

As of Thursday, health insurance companies will no longer be allowed to deny coverage to children because of preexisting conditions, stop providing coverage to customers because of technical errors on past applications or impose lifetime dollar limits on essential benefits -- as was done to Mira.

"Some of the worst abuses of the insurance companies are going to cease to exist," Health and Human Services Secretary Kathleen Sebelius told ABC News. "People will have some stability behind the plans they paid for."

Sheryl Raether said a huge weight will be lifted from her shoulders with the new rules.

"Knowing that we don't have that financial burden, we'll be able to take her to a doctor and know that we have insurance to fall back on," she said.

Insurance companies are obligated to include the new measures when health insurance policies are renewed, starting on or after Sept. 23, 2010. Which means that if an insurance policy is renewed on Sept. 1, those covered under the policy may not be eligible for the benefits under the new law until Sept. 1, 2011.

Additionally, several provisions may vary depending on where people live. The way high-risk pools are implemented vary from state to state, for example, as do the limits on how much insurance companies can raise their premiums.