Breastfed baby denied coverage

[emerald]

Breastfeeding infant labeled obese, denied health insurance
by desmoinesdem

Breastfed babies can be long and lean, short and fat, or anywhere in between. But I never heard of an insurance company citing a breastfeeding infant's "obesity" as a pre-existing condition.

Link:

By the numbers, [four-month-old] Alex [Lange] is in the 99th percentile for height and weight for babies his age. Insurers don't take babies above the 95th percentile, no matter how healthy they are otherwise. [...]

Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.

" 'Your baby is too fat,' she told me," Bernie said.

Up until then, the Langes had been happy with Alex's healthy appetite and prodigious weight gain. His pediatrician had never mentioned any weight concerns about the baby they call their "happy little chunky monkey." [...]

"I'm not going to withhold food to get him down below that number of 95," Kelli Lange said. "I'm not going to have him screaming because he's hungry."

Good call, Mrs. Lange. There is "no evidence to support 'dieting' or substituting other foods or liquids for human milk to reduce weight gain."

It's outrageous for an insurance company to use Alex's weight at four months of age as an excuse to deny coverage.

Also, this family wouldn't have been shopping around for new coverage if their previous carrier hadn't raised their rates by 40 percent after Alex was born. I remember our insurance premiums went up quite a bit after our second child was born, but I don't think it was by that much. Then again, they went up 10 percent last year even without any new babies or health problems in our family.

WTF:confused:

[TiQuinn]

Now if they just fed the kid via the bottle like normal people, this wouldn't have happened.

[Xavier Lang]

If the kid is in the 99th percentile for height and weight, you shouldn't classify them as obese. 220lbs may not be obese if your 2m tall. It is if your only 1.3m tall.

[Kastil]

My kid was always off the charts for his age. How about changing the charts?

[Kyle Voltti]

1: those charts have nothing to do with overall health no mater what crappy daytime TV like the doctors want to say

2: can we all just agree that Insurance companies are EVIL

[Scarbonac]

Maybe if the fucking kid ate a goddamn salad once in a while, they wouldn't have this problem.

[Morbidity]

Or perhaps children including babies over the 95th percentile have historically been associated with developing expensive health conditions, which is why the insurers won’t take them.

Yes, yes it’s lots of fun to talk about the evil insurance companies, but believe it or not they make money by insuring people not by turning them away and they usually have statistical evidence to support the decisions they make.

I've no idea what the validity of this particular situation is, but as I spent a few years of my life writing to complaints agencies to explain the statistical evidence which justifies discrimination like this, I'm more inclined to believe that the insurer's assessment is valid.

[emerald]

Or perhaps children including babies over the 95th percentile have historically been associated with developing expensive health conditions, which is why the insurers won’t take them.

Yes, yes it’s lots of fun to talk about the evil insurance companies, but believe it or not they make money by insuring people not by turning them away and they usually have statistical evidence to support the decisions they make.

I've no idea what the validity of this particular situation is, but as I spent a few years of my life writing to complaints agencies to explain the statistical evidence which justifies discrimination like this, I'm more inclined to believe that the insurer's assessment is valid.

The charts in question are based on the growth patterns of formula fed babies not breastfed babies and on average breastfed babies are larger and healthier. And how can an assessment that this child should be denied basic childhood coverage that can prevent so many problems later in life be valid?

[TiQuinn]

The parents could just have a chat with their pediatrician about whether the scale might be a tad heavy.

[Enk]

Or perhaps children including babies over the 95th percentile have historically been associated with developing expensive health conditions, which is why the insurers won’t take them.

Yes, yes it’s lots of fun to talk about the evil insurance companies, but believe it or not they make money by insuring people not by turning them away and they usually have statistical evidence to support the decisions they make.

I've no idea what the validity of this particular situation is, but as I spent a few years of my life writing to complaints agencies to explain the statistical evidence which justifies discrimination like this, I'm more inclined to believe that the insurer's assessment is valid.

It's hard to argue with actuarial tables.

This is a good example of why we need a real safety net for health care, to catch the individuals who the actuarial tables say are a hefty drain on the current system.

[Ancalagon]

So this insurance company rejects 1/20 babies - well, they probably reject the bottom 95% percentile too, so they reject 1/10 babies.

That's what they are doing.

[Brynja]

It's hard to argue with actuarial tables.

This is a good example of why we need a real safety net for health care, to catch the individuals who the actuarial tables say are a hefty drain on the current system.

Look it is easy to jump on Morbs but I see her point. There may be data we don't know about.

THAT SAID...if it is true breast fed babies are more robust than formula fed babies then those charts don't really matter.

[Enk]

Look it is easy to jump on Morbs but I see her point. There may be data we don't know about.

THAT SAID...if it is true breast fed babies are more robust than formula fed babies then those charts don't really matter.

Actually, I was agreeing with Morbs, and trusting that she knows more about actuarial stuff than I do (being, you know, an actuary).

I was also making the point that when math actually tells you that you are logically in the wrong, it doesn't make sense to argue with it.

[Brynja]

Oh I couldn't tell! I was sure you were being deadpan.

Sorry!

[Varaj]

Get that little fucker on a treadmill. :)

With breast feeding it is pretty easy to get on nice healthy plump kid. Doctor's don't consider it overweight if it is from breastfeeding. If it was formula the doctor would be all over it. Stupid insurance company. :mad:

[Aloysius]

Obama's death panel are refusing breastfed baby the right to live !

(or is that a private assurance ?)

[Name Lips]

Obama's death panel are refusing breastfed baby the right to live !

(or is that a private assurance ?)

Sadly, we don't have Obama Death Panels yet. :(

[Random Encounter]

Or perhaps children including babies over the 95th percentile have historically been associated with developing expensive health conditions, which is why the insurers won’t take them.

Yes, yes it’s lots of fun to talk about the evil insurance companies, but believe it or not they make money by insuring people not by turning them away and they usually have statistical evidence to support the decisions they make.

I've no idea what the validity of this particular situation is, but as I spent a few years of my life writing to complaints agencies to explain the statistical evidence which justifies discrimination like this, I'm more inclined to believe that the insurer's assessment is valid.

Insurance companies are a business. And like all businesses they exist to make money.
Which is why I find it so fucking ridiculous the way people scream about "Death Panels" and the "Nazi-like" way the Democrat's healthcare plan "will deny coverage for those people it feels are too expensive to treat".
What do these people think we have now?
Right now who is and is not covered is based on profit margins. I'm not saying that's evil, it's just the nature of a business. Now whether or not the nature of a government-run agency is any more acceptable when it comes to health concerns is another question entirely.

[Morbidity]

Exactly, insurance companies are a business, so if you allow them to discriminate where they have statistical evidence then they will do so. Or you legislate that insurers can’t discriminate. In Australia, health insurers can’t discriminate, so you get charged the same premium regardless of whether you are the healthiest person in the world or the unhealthiest. This makes private health insurance expensive and unattractive as healthy people are subsidising very unhealthy people. However we also have the public health safety net, so private health insurance is really about elective surgery and the ability to choose your own doctor and be treated in a private hospital rather than a public.

[Dawnstar]

This really upsets me. If a child is breastfed they can be larger than formula fed babies. And breastfeeding has been proven to help the babies future health. So for a insurance company to deny coverage is really upsetting. Don't they understand that ones the child starts to crawl then walk, they will most likely loss a good amount of weight? So should they wait for a couple months then try again? Can they??

[Name Lips]

Plus medical coverage in the early years is important - how else will the baby get checkups and vaccinations?

[Morbidity]

This really upsets me. If a child is breastfed they can be larger than formula fed babies. And breastfeeding has been proven to help the babies future health. So for a insurance company to deny coverage is really upsetting. Don't they understand that ones the child starts to crawl then walk, they will most likely loss a good amount of weight? So should they wait for a couple months then try again? Can they??
I'm sorry it upsets you Dawnstar and as I said I have no knowledge of the specifics of this case and whether or not it is justified. I have however had to as part of my job defend decisions like this to discrimination tribunals and the statistical evidence in favour of the decision has always been overwhelming.

Insurance companies make money by insuring people, not by turning them away or getting bad PR by not insuring babies. Thus decisions like this are not made lightly. For these reasons I suspect that there is statistical evidence to support the company's decision.

Decisions like this always upset parents. Often medical practitioners are not completely honest with parents about the future health prospects of their child preferring to focus on the most optimistic outcome. The parents then try to get insurance and are knocked back and get upset because it goes against what the health practitioners have been telling them. One case I was involved with, had a child who had needed heart surgery at 6 weeks. Post surgery there was an 80% chance that she would be fine and live normally and a 20% chance she would die before the age of 8. The doctors had minimised the second outcome to the parents who then became extremely angry that they couldn't get insurance for the child and took the insurer I was working with to court. It was a lose/lose scenario for the insurer b/c although we won the case easily, the headlines of evil insurer won't insure child were extremely bad PR.

Unfortunately, insurance is about the cold numbers and facts, not about optimistic assessments or the warm and fuzzy.

If the child's situation changes, then they can always try again. A common insurance decision is actually not rejection, but delay ... telling people we won't insure you now, but if you try again in 6/12 months and nothing adverse has occurred in that time we probably will. A good example of this is where someone has just had a heart attack. There is a really good chance that they'll have another one shortly thereafter which may actually kill them. Therefore many life insurers will not insure someone within 12 months of them having had a heart attack, but will insure them thereafter. Depending upon the questions the insurer asks the parents may or may not have to disclose that they have been refused insurance in th past, but even if they do disclose it, it won't necessarily impact the underwriting decision.

[Scutisorex Shrewlord]

Or perhaps children including babies over the 95th percentile have historically been associated with developing expensive health conditions, which is why the insurers won’t take them.

Yes, yes it’s lots of fun to talk about the evil insurance companies, but believe it or not they make money by insuring people not by turning them away and they usually have statistical evidence to support the decisions they make.

I've no idea what the validity of this particular situation is, but as I spent a few years of my life writing to complaints agencies to explain the statistical evidence which justifies discrimination like this, I'm more inclined to believe that the insurer's assessment is valid.

Ah, the voice of reason.

[Name Lips]

http://www.msnbc.msn.com/id/33411196/


Toddler denied insurance for being too small
Aislin Bates, 2, weighs just 22 pounds but her doctor says she is healthy

First, a Colorado baby was turned down for health insurance for being too big. Now, another Colorado child has been turned down for health insurance for being too small.

Just a week after TODAY highlighted the story of 4-month-old Alex Lange, who at 17 pounds was considered obese, the show presented Wednesday the equally curious case of 2-year-old Aislin Bates, who at 22 pounds was turned down for health insurance for not meeting a proposed insurer’s height and weight standards.

Aislin’s dad, Robert Bates, told TODAY’s Erin Burnett he was shocked that United HealthCare turned down their request for coverage when their daughter is basically a picture of health, having suffered nothing more than a common cold in her life. Doctors have told Robert and his wife, Rachel, that Aislin’s small size is purely a matter of genes, not ill health.
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“It seems as if they’re discriminating about the fact that she’s smaller, that her size is an issue,” Robert Bates said. “I don’t see why that would be a factor in whether or not a child is healthy.”

Bates told TODAY that he and his family were previously insured by United HealthCare. Two months after Aislin was born, his employer switched plans to Guardian Health Insurance. In August, Bates left his job to become self-employed, and he went back to United HealthCare requesting coverage. The insurer turned down coverage for Aislin — even though it had already insured Aislin as an infant — stating she did not meet height and weight standards and also noting the Bateses had sought treatment for Aislin’s finicky eating habits.

Doctor says child is normal
As the Bateses appealed the decision, their own family doctor went to bat for them, writing to the insurer and stating Aislin’s small size was genetic, that she was developing normally and there was no reason to deny coverage. But Robert Bates said the company rejected the appeal, simply reiterating that Aislin didn’t meet underwriting standards.

Rachel Bates told Burnett their daughter “is not sick at all; she’s just petite, and that’s the issue.” She said little Aislin has been graded in the 3rd percentile for child height and weight, but has been progressing normally in her own range.

Robert and Rachel realized Aislin was a picky eater early on, and went the extra mile to enroll her in food therapy. But instead of earning brownie points with the insurer, the family believes having their daughter in treatment is actually being held against them.

Therapy for picky eating
“We wanted to fix her picky eating, because we want her to be able to eat a wide variety of foods, and not just things she wants to eat, like chocolate,” Rachel Bates told TODAY.

“We personally sought out therapy; it was not prescribed by a doctor. In the process, it was found that [Aislin] has just a minor, minor gag reflex, causing her to not like certain foods. But the therapist says she’s thriving and fine, and she’s developing normally and in fact, possibly advanced.”

Appearing on TODAY with the Bates family, which also includes 3-month-old boy Elliott, Dr. Nancy Snyderman quickly broke in when Burnett professed she didn’t understand what the problem is with insuring Aislin.

“You don’t understand? Because there’s nothing here to understand,” Snyderman said. “This is just so bogus. A pre-existing condition for a child this age is birth, let’s be real!”

The case of Alex Lange had a happy ending. After the family appeared on TODAY, Rocky Mountain Health Plans reversed its decision and agreed to insure the child, and admitted there was a flaw in its underwriting system.

‘Cherry-picking of health plans’
Robert Bates, to date, has had no such luck. While he continues to lobby United HealthCare to cover Aislin, the family has been forced to look at other options. Aislin is currently insured under a COBRA plan from Bates’ previous job, but it expires in 18 months.

Snyderman was clearly agitated that the Bates family has to go through worry and uncertainty over insuring Aislin, and said her prognosticating skills have unfortunately been proven accurate.

“Last week we talked about how crazy it was that there was a chubby baby being denied, and I said next thing you know, we’ll hear about the skinny kid. So here’s the skinny kid,” she said, pointing to Aislin.

“I think what we’re really seeing is the cherry-picking of health care plans across the country,” Snyderman said, adding, “If anyone doubted the significance of health care reform in this country, this is why things have to change.

“This is egregious.”

[Lady Fury]

Wow. I hope none of my kids get denied benefits because of their genetic height and weight issues. My 4 yr old daughter is very petite while my 3yr old son is husky. They both weigh the same and are the same height. Their doctor says they are both normal for their body types. People think I have fraternal twins.