Newborn With Pre-Existing Condition Gets Coverage

Insurance company offers to pay for newborn caught in insurance coverage gap.

ByABC News
April 2, 2010, 11:32 AM

April 2, 2010— -- Houston Tracy made the rounds on national blogs before he was even a month old.

At 12 days old, he already had survived a rare birth defect, a feeding tube and open-heart surgery.

But his family was in a battle with an insurance company to get his surgeries covered. His parents, Kim and Doug Tracy of Crowley, Texas, didn't have health insurance for themselves. The Tracys said insurance agents assured them they could buy health insurance for Houston once he was born.

But then, Houston's parents found out that the term "pre-existing condition" can apply the moment someone is born.

Doug Tracy, 39, called his congressmen. Then the local news media spread the word.

"People from Sweden, from Australia were calling me," Doug Tracy said.

Soon, Darren Rodgers the C.E.O. of Blue Cross and Blue Shield Texas called Tracy too. Within a few days of negotiations, Tracy said he had a letter from Rodgers that promised to pay for Houston's surgery and offered him insurance coverage.

"I feel thankful and I feel blessed," said Tracy.

Following is the story of the Tracy family's confusing struggle to get health insurance for Houston when his mother and father were not already covered.

"When he came out, he made one little cry and he didn't really cry much," said Doug Tracy.

Tracy cut the umbilical cord and watched the hospital staff clean his son. But before his wife, Kim Tracy, 36, could touch their son, doctors got worried.

"We could tell there was something wrong by the way they [the doctors] were acting," Doug Tracy said.

Houston's skin wasn't turning a shade of pink like most newborns because, somehow, his blood wasn't getting enough oxygen.

Doctors rushed Houston, with Doug Tracy riding by his side, in an ambulance to Cook Children's Medical Center in Fort Worth, Texas.

Within hours, the Tracys would learn their son was born with a heart condition called d-transposition of the great arteries, meaning the aorta and pulmonary artery are transposed where they should meet the heart. Doctors wanted to operate within days to save his life.

"In Houston's case, he would not have survived had he not gotten the care," said Dr. Steve Muyskens, a pediatric cardiologist at Cook Children's Medical Center who treated Houston. "Most children with this [would] have a demise within days to months."

Muyskens said that with the aorta and pulmonary artery switched, the system creates two separate pools of blood -- a small amount that travels from the heart to the lungs and back to the heart, and another pool of blood that travels from the body to the heart and back out without ever reaching the lungs for oxygen.

"The red blood just circles on one side and blue blood circles on the other," Muyskens said.

All of Houston's organs, including his heart, would soon die without red blood.

Even if doctors could stabilize a child with Houston's heart condition, they would only have a short window to operate.