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Denied Insurance coverage
White House summit on health care reform, Feb-25-2010 Sen. Reid: $90,000 medical bill to fix child's cleft palate
The White House
Office of the Press Secretary
February 25, 2010
SENATOR REID: Mr. President, my friends in the House and in the Senate, I want to spend a few minutes talking about Nevada, about our country, and not what's going on here in Washington. I want to start by talking about a young man by the name of Jesus Gutierrez. He works hard. He has a restaurant in Reno, Nevada. He had everything that he wanted, except a baby. He had health insurance. He had employees that liked him. But he was fortunate -- they were going to have a baby and it was going to be a little girl. And the baby was born, and in just a few minutes after the birth of that baby, he was told that the baby had a cleft pallet. "But that's okay," he was told. "We can take care of that." And they did. They did some surgery on the baby; he was happy -- that is, Jesus was happy -- until he got his mail four months later, opened the envelope, and the insurance company said, "We didn't realize that your baby had a preexisting disability. (bold added) We're not covering the $90,000 in hospital and doctor bills you've already run up." So he's trying to pay that off. The baby needs a couple more surgeries. This shouldn't happen to anyone in America. He had health insurance. He paid his premiums.
Also see National Public Radio (NPR), A Health Care Issue Both Parties Can Agree On,
"...Senate Majority Leader Harry Reid told of a constituent, Jesus Gutierrez. Gutierrez and his wife had a baby who had a cleft palate. Surgeons fixed the cleft
palate, but then, Gutierrez says, his insurer wouldn't pay. "They told us that she cannot be insured," he
says. "My wife and I can be insured, but she cannot be insured because she had a pre-existing condition.""
"Gutierrez and his wife were left with $98,000 in medical and surgical bills. They now buy their insurance from another company..."
Extraordinary Expenses $153,341.68 minimum, adjusted 2014
Extraordinary Expenses of CL&P. Page 4, "the $100,000 minimum individual lifetime costs of treating craniofacial birth defects such as cleft lip and palate"; on page 228, "In California, the lifetime cost per case for cleft lip/palate repair is estimated at $101,000 (Waitzman et al. 1996)." The numbers are 18 years old.
In 2014 with inflation, the adjusted amount is about $153,341.68
How I feel about having a cleft lip, my views on the care provided in Glasgow, Scotland and ideas I have for bettering the service.
Judge blasts Florida for depriving children of
Miami Herald Blog
By Carol Marbin Miller
January 1, 2015
A federal judge Wednesday declared Florida’s healthcare system for needy and disabled children to be in violation of several federal laws, handing a stunning victory to doctors and children’s advocates who have fought for almost a decade to force the state to pay pediatricians enough money to ensure impoverished children can receive adequate care.
In his 153-page ruling, U.S. Circuit Judge Adalberto Jordan said lawmakers had for years set the state’s Medicaid budget at an artificially low level, causing pediatricians and other specialists for children to opt out of the insurance program for the needy. In some areas of the state, parents had to travel long distances to see specialists....
Among Jordan’s findings: Almost 80 percent of children enrolled in the Medicaid program "are getting no dental services at all." more
Florida illegally deprived needy kids of healthcare, judge rules, see Florida Pediatric Society et al v. Liz Dudek, et al., Case No. 1:05-cv-23037-AJ, Order (Doc. 1294) Findings of Fact and Conclusions of Law (153 pages), U.S. District Court, Southern District of Fla. Order filed Dec-30-2014, Hon. Adalberto Jordan.
Dr No (Rep. Farkus): No health insurance for cleft palate
Angry crowd lashes lawmaker over lack of public testimony
By Times staff and wire reports
St. Petersburg Times, February 8, 2002
TALLAHASSEE -- A crowd of angry consumers hoping to testify against a health insurance bill exploded in anger Thursday when the panel's chairman, Rep. Frank Farkas of St. Petersburg, pushed through a vote on his own bill without allowing public testimony.
The only testimony was from an insurance industry lobbyist who favors the bill.
"I hope you can sleep," Arthur Green, a Broward County lawyer, shouted at Farkas after the meeting of the House Health Regulation Committee. "It was absolutely
outrageous. I needed to express that."
Green drove more than 400 miles from his Coral Springs home to testify against the bill. He and many other witnesses who went unheard are parents of children born with a cleft palate, a condition requiring many expensive medical operations. Green was one of about a dozen people who charged out of their seats and screamed at Farkas as the hearing ended.
"I'm getting blamed for it, but I wasn't running the meeting," Farkas said later. "I welcomed that testimony. I wasn't there to cut these people off."
Farkas has been trying to pass the bill for three years. His bill (HB 913) would give employers a choice of buying flexible health plans while allowing them to opt out of covering 18 treatments that now must be covered, including cleft palate, mammograms, vasectomies and extended maternity stays. read more
Fla. Attorney General Pam Bondi’s failed States Healthcare Lawsuit Challenging the Constitutionality of the Health Care Reform Law.
Affordable Care Act upheld by the U.S. Supreme Court.
Insufficient Fla. program for habilitation of birth defects
In my view Florida does not have an adequate program of habilitation for persons born with physical birth defects. Therefore, I believe a constitutional challenge [FRCP 5.1] [Fla.R.Civ.Pro. 1.071] is needed to amend the Florida Unborn Victims of Violence Act to include all unborn children. Otherwise a law that only protects certain unborn children in a few circumstances appears unconstitutional. (note, this is not a notice under the rules)
............Florida Unborn Victims of Violence Act..............
The Florida legislature recently passed the Florida Unborn Victims of Violence Act, Bodily injury to an unborn child, CS/HB 59: Offenses Against Unborn Children, found at these links,
CS/HB 59: Offenses Against Unborn Children
Offenses Against Unborn Children; Designates act as "Florida Unborn Victims of Violence Act"; provides rule of construction that person who engages in conduct that violates Florida Criminal Code or criminal offense defined by another statute & causes death of, or bodily injury to unborn child commits separate offense if such offense is not specifically provided for; provides for penalties; specifies that certain types of knowledge or intent are not necessary for such offense; provides exceptions; revises definitions & terminology.
Florida House, Enrolled CS/HB 59, 2014 Legislature (PDF)
Historical Opinions on cleft palate: Florida's Attorney Generals
Historical Opinion Entry-Fla. AGO 62-122[...]
Adobe Acrobat document [169.5 KB]
Biannual Report of the Fla. Attorney Gen[...]
Adobe Acrobat document [185.0 KB]
Opinion-T.F.West Fla. Attorney General 1[...]
Adobe Acrobat document [201.5 KB]
.....Failed birth defect legislation in the United States....
The Treatment of Children’s Deformities Act was proposed and rejected over and again. In 2005, for example, the bill died in committee. https://www.govtrack.us/congress/bills/109/hr1000
The names of these bills - Children’s Deformities Act - are patronizing to afflicted adults; a birth defect is a life-time commitment requiring extraordinary treatment and expense.
Oral and Maxillofacial Surgeons applaud Congresswoman McCarthy's legislation to require insurance coverage for children with congenital deformities
The American Society of Plastic Surgeons (ASPS) applauds introduction of CARES Act of 2011
ASPS Applauds Introduction of Legislation to Increase Access to Reconstructive Surgery for Children
Thank you Enoch for sharing your cleft palate story.
You are a courageous man, and an inspiration to all people.
See the YouTube Channel for Enoch Clark Zhao.
Stop Insurance Denials for Cleft & Craniofacial Patients in the United States! Sign the peititon
PDATE NOVEMBER 2014 - PLEASE NOTE: The Reconstructive Surgery Act (Thomas), legislation that will cover cleft/craniofacial patients of ALL ages, has not yet been re-introduced to this session of Congress. Neither has the Children's Access to Reconstructive Evaluation & Surgery (CARES) Act (S. 1045., H. R. 1955), which covers patients from birth only through age 21. Continued delays are expected due to implementation of the Affordable Care Act (ACA Rights) and the ongoing healthcare debate, as well as election season and the seating of the 114th Congress in January 2015. Please sign the petition in support of eliminating healthcare disparities for cleft/craniofacial patients! Continue to check the website for updates and new bill numbers when they become available with each new session of Congress.
The 2014 Florida Statutes, Title XXXVII, Insurance
627.64193 Required coverage for cleft lip and cleft palate.—A health insurance policy that covers a child under the age of 18 must provide coverage for treatment of cleft lip and cleft palate for the child. The coverage must include medical, dental, speech therapy, audiology, and nutrition services only if such services are prescribed by the treating physician or surgeon and such physician or surgeon certifies that such services are medically necessary and consequent to treatment of the cleft lip or cleft palate. The coverage required by this section is subject to terms and conditions applicable to other benefits. This section does not apply to specified-accident, specified-disease, hospital indemnity, limited benefit disability income, or long-term care insurance policies.
History.—s. 1, ch. 98-66.
627.66911 Required coverage for cleft lip and cleft palate
641.428 Nondiscrimination of coverage for certain surgical procedures involving bones or joints
641.31094 Nondiscrimination of coverage for certain surgical procedures involving bones or joints