Another Aspect of Pediatric Disease

May 02 2017 Published by under [Medicine&Pharma]

Jimmy Kimmel gave an emotional monologue this week about his newborn son’s congenital heart disease and the implications it has for his life with a preexisting condition. His pleas for coverage of all children with repairable conditions are important; as he says:

If your baby is going to die, and it doesn’t have to, it shouldn’t matter how much money you make.

Now stories of babies will get the crowd going, and most of the poor will be covered by Medicaid, at least for their initial care. It’s actually more difficult for those with some money and some coverage.

Insurers often require the use of provider networks. There may only be a single hospital in your state that provides the sort of pediatric specialty care we are discussing here. Are they in your network? If not, new parents could face thousands of dollars out-of-pocket, even with “good” insurance.

I understand insurers trying to limit their  expenses through limited contracts. For well child care and a number of other conditions, there may be enough providers distributed about to make networks a good solution. For pediatric specialty care, that often is not the case.

I would like to see network requirements and penalties not be enforced when there is no appropriate provider in network. Perhaps we can get that added to those basic health coverage requirements.

Oh wait, never mind. This is one more thing to eliminate.

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