Our baby can eat your actuary.
Posted on 10/12/2009 10:59:11 AM PDT by BGHater
Frustrated parents of a big infant who is being denied insurance view the system as "absurd."
Alex Lange is a chubby, dimpled, healthy and happy 4-month-old.
But in the cold, calculating numbered charts of insurance companies, he is fat. That's why he is being turned down for health insurance. And that's why he is a weighty symbol of a problem in the health care reform debate.
Insurance companies can turn down people with pre-existing conditions who aren't covered in a group health care plan.
Alex's pre-existing condition — "obesity" — makes him a financial risk. Health insurance reform measures are trying to do away with such denials that come from a process called "underwriting."
"If health care reform occurs, underwriting will go away. We do it because everybody else in the industry does it," said Dr. Doug Speedie, medical director at Rocky Mountain Health Plans, the company that turned down Alex.
By the numbers, Alex 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.
"I could understand if we could control what he's eating. But he's 4 months old. He's breast-feeding. We can't put him on the Atkins diet or on a treadmill," joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. "There is just something absurd about denying an infant."
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."
His 2-year-old brother, Vincent, had been a colicky baby who had trouble putting on pounds.
At birth, Alex weighed a normal 8 1/4 pounds. On a diet of strictly breast milk, his weight has more than doubled. He weighs about 17 pounds and is about 25 inches long.
"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."
Speedie said not many people seeking individual health insurance are turned down because of weight. But it does happen. Some babies less hefty than Alex have had to get health endorsements from their pediatricians. Adults who have a body-mass index of 30 and above are turned down because they are considered obese.
The Langes, both slender, don't know where Alex's propensity for pounds came from. Their other child is thin. No one in their families has a weight problem.
The Langes are counting on the fact that Alex will start shedding pounds when he starts crawling. He is already a kinetic bundle of arm- and leg-waving energy in a baby suit sized for a 9-month-old.
They joked that when he is ready for solid food, they will start him on Slim-Fast.
Meanwhile, they made Alex's plight public on KKCO this week. They plan to appeal Rocky Mountain's denial.
If that doesn't work, they plan to take their case to the Colorado Division of Insurance.
"My gripe is not with Rocky Mountain," Bernie said. "It's with the general state of the health care system."
So did every college football recruiter in America.
Lol. My bad, but the Broncos would be happy.
We need to keep in mind that this family and this child is/are NOT denied health CARE for their child, they simply cannot get underwriters to agree to cover the RISK of potentially paying out too much for the care of this child.
Now, we can argue about whether a fat infant IS a high risk, and do so clinically. Or we can simply repeat the THAT’S NOT FAIR rant of the liberals.
Personally, I am not certain WHAT the clinical risk is associated with a breast fed baby in the 99th percentile. There *MAY* be other factors at play here that are not in the press.
But we should argue ONLY if the underwriting risk assessment is right or not. Why? Because the child is NOT denied health care, only insurance from this underwriter.
IMHO
‘Rocky Mountain Health Plans, the company that turned down Alex. ‘
That only leaves hundreds of other insurance companies. Next.
Was he completely, unconditionally denied, or was he offered insurance at a higher risk (more expensive) rate?
Not the best written article I've ever read, but if I understand this, the family had medical coverage, and after the new baby was born, their carrier raised their rates by 40% because of the baby's weight. If so, this is sort of crap the insurance company's should not be allowed to do. And all conservatives and Republicans who oppose Obamacare and other socialized medicine schemes should also oppose this sort of behavior from insurers.
And our bought and paid for reps and senators should have taken steps to correct this sort of thing years ago. Not doing so gives the Obamacare supporters ammunition they shouldn't have. There are many legitimate reforms that should have been made years ago, but if we had the full story, I bet campaign contributions to Republicans when they were in the majority would tell us why basic and reasonable reforms were never enacted.
We might pay a dear price for that, but hopefully not.
That probably describe my oldest son.
He was nine pounds when he was born. The rule of thumb is double the birth weight at 6 months and triple it by one year.
He was perfectly healthy.
I have to disagree —
this is not “crap”. The insurance company now has to cover a postpartum mother AND an infant with demonstrable if arguable health risks. Insurance companies cover the risk of costs they might inure. Insurance is a substitute for cash.
Prior to the birth of this child, the couple were likely relatively low consumers of health care, ie they were low risk and thus low premium. Children , particularly infants WILL raise anyone’s premiums. This was not selective or prejudicial, or crap.
Now, is the baby REALLY an at-risk child? perhaps. But the insurance company was not wrong to raise premiums if the risk went up; no more than if they lowered premiums when risk went down.
‘On a diet of strictly breast milk,’
The best recipe in the world.
Just for grins, I went to http://www.babycenter.com/baby-child-growth-percentile-calculator
According to this calculator as well as one I tried at answers.com, this baby is in the ~10th percentile for height (or so) and somewhere in the 70th - 90th percentile for weight. So ... he is a short Michelin baby at this point. I have no idea of the REAL clinical risks though.
(BTW, I do not work in the insurance business, nor does any of my family)
If I remember correctly, my son was about 25 lbs at 6 months. He is now 25, 5’9”, and about 165 lbs, solid muscle.
When my son was a baby, he was always in the 99th percentile, on weight and height. He weighed 9lbs at birth, 12 at one month, 15 at two months, and kept gaining weight until he was 30 lbs at a year. 40 lbs at 2 years...and then he quit gaining weight and starting getting taller and still weighed 40 lbs at 4 years old.
Today he’s a 6’2” 170 lb man who has never in his life had to “watch” his calories, and his bloodwork shows his cholesterol, etc. is right where it should be.
I don’t believe for a minute that being a “fat” baby automatically leads to health problems later in life.
My nephew weighed 25 lbs. at about 4 months.
Definitely crap and that's putting it nicely. This was already a family of a father, mother and a first child. They had FAMILY coverage, and they and/or their employer would have been paying around $1,000/month for that coverage. When a company offers family coverage, they know children will be born in most young families, and should not be able to raise premiums when a new child is born less than perfect. And no one even knows the cause of the child's weight. And, premiums as based upon some percentage of health problems, including in newborns. That's already factored into the premiums.
You might not think it's crap, but if people keep opposing reforms that will end this sort of behavior from insurers, they will guarantee that something like Obamacare will eventually pass.
And, I worked with insurance some in the past, and at that time the group policies I saw had only one family rate, no matter how many children were in a family. Not sure if that's the case all over.
I have to agree. My daughter was an oinker at birth; but was a peanut til 9; and is now a 5’11” powerful swimmer in great shape.
So, do you also think that life insurance companies should be able to raise premiums on life insurance if long standing policy holders are diagnosed with a life threatening illness?
The addition of a third individual into the mix makes is a family plan which justifies a significant increase in the rate. Most plans for hushand and wife are not a family plan. The family should shop around for diferent insurance.
“already factored into the premiums” is a key phrase. *IF* this company has ethical and legitimate actuarials, they somehow saw an increased risk of coverage and raised the premiums.
Or they simply wanted to raise their prices (also their corporate right, vis a vis price elasticity) to improve their margins.
We are not OWED or entitled to having our risks covered at a loss in private enterprise; unless we want those covering the risks to operate at a loss.
I cannot say if the insurance company’s actions were ethical, but I believe they have a right to evaluate risks of providing coverage and alter pricing as needed. Would anyone object if this company LOWERED prices after evaluating risks? Or do we only object when the costs of covering altered risks go up?
Yep. When I took up car-racing and skydiving in the 80s, my premiums went up, and I had to add a special rider. When I quit that, after two years, my rates went down.
When I passed a certain age, my premiums went up again.
When I suffered certain injuries and surgery (not related to racing or airplanes) my premiums went up because my risk of death by a certain age went up.
It’s just math, not animus. Insurance is a substitute for cash, and the insurance companies rely on fancy to math to make certain they can cover likely costs ... and still make a profit. And that is OK with me.
I don’t HAVE to buy their product, afterall.
The baby’s birth was covered by the unnamed company they most likely currently carry; that company raised the policy price by 40% after that payout and the family went shopping — beyond that, nothing can be derived from this article.
Simply put they aren’t giving us the facts re the current coverage. They can’t raise the rate if it was already a family nor can they increase it due to the health of the newborn. There was another factor in the 40% increase, e.g. an age increase or some other.
They went shopping for less expensive insurance and the very underwriting which itself is a major factor in those low rates is their undoing. This entire piece is a set up where the writer went looking for someone w the profile to fit the desired outcome. A friends wife went into journalism and I was on the list for her searches when she would define the types of people they needed for x article and did we know anybody who fit the bill. Then they write the story to tell their story.
Not necessarily true. When my daughter was born almost four years ago, she was 9 pounds 0.1 ounce, and grew like a weed. She was 97+ percentile height and weight at six months, and we had no trouble adding her to my insurance through my job (BCBS of Massachusetts).
BTW, she's not fat, but she's 3 3/4 now, and she's damn near four feet tall. She's taller than the six-year-old daughter of a friend! She's still supposedly 95th percentile for her age, height-wise, and showing no signs of stopping her growth. She's currently wearing 5T stuff and she'll be outgrowing that soon enough.
}:-)4
Their other child is thin. No one in their families has a weight problem.
Did you even read the article?
And a husband and wife does pay for family coverage unless both work and have separate policies, in most states. Can't be positive because each state regulates the insurance industries to an extent.
But since you've delved into such specifics, if there is only a husband and wife, and a first baby is born, does your non-family policy pay for the delivery?
Do you have specific knowledge of plans that cover a husband and wife, and that plan is not a family plan? Where are such plans written, unless for older couples beyond childbearing age?
Sure they do. I know, first hand.
Shoddy journalism.
If only pure buisness considerations are taken into account,
many of us would not be able to afford health care at
current prices since we would be uninsurable.
If you make a moderate income, are diabetic,
and require dialysis to survive, insurer/government denial of benefits guarantee a death sentence once your home/goods/saving have been sacrificed.
Is it in the public interest that less-than-perfect specimens should be denied needed care because insurers
do not deem them a good risk, and that they cannot purchase
care outright? I don’t think its moral or Christian to
expect these people to just go outside and die quietly.
Not an easy question.
I've considered the possibility that some key facts are missing. And, because each state does regulate the insurance industry, I hesitate to say what I know for my area applies everywhere else. But, if this family had coverage for the the couple and their first child, it would had to have been family coverage where I live. And no company should be able to raise premiums if a second baby is born with a health problem of any type. All the known and possible health problems and factored into premiums.
And this might be a bogus, sob story article that contains errors, but you'd think a major paper would avoid that.
But it's fairly amazing to see anyone defend the practice described here. They must be secretly working to be Obamacare passed.
‘huge babies have developmental problems and would be quite costly to cover. ‘
I’m sure there is an inverse as well. Pre-mature[Small] babies might not get coverage as well.
Yes, but all the possible good and bad health outcomes are factored into the premiums charged. So, the question has already been answered for the insured who pay their premiums on time.
This article seems fairly suspicious and might not provide factual information, or might be leaving something out. But no company should be allowed to raise rates on a family just because an infant is overweight. Heck, that might not even be a problem. Premie care can costs into the six figures.
So, are you saying that there are family medical policies, that do cover maternity costs, but that would not cover the additional cost of premature births?
Our baby can eat your actuary.
You are right I forgot about the other son. The family policy would not change just with the addition of an additional child, something else must be going on.
Yes a non-family plan would cover delivery. Most of my experence is with employer plans. Have not looked at non family plans for individuals.
The baby has already signed a “Letter of Intent” with USC.
My father in law weighed 14 pounds at birth. I was a tad frightened with my sons but they only weighed in at 10 pounds.
The information presented in this article seems questionable. I saw all health insurance bills for three companies for over 20+ years, all in the same state. For those polices, there was only one rate for individual coverage, and one rate for family coverage no matter how many children. And a husband and wife paid the family premium unless they both happened to have coverage under separate polices.
Since states regulate insurance within their boundaries, I don’t know if what I saw was common elsewhere, or what part of it was required by law and what was simply those specific policies. But if these things that most will think treat people unfairly aren’t eliminated, we’ll get Obamacare or something like it (if we dodge it this time).
I do recall a change that came down (probably a court ruling) that required all family policies to include the out-of-wedlock births to minor daughters covered by the policy.)
Lots of babies are fat....what is the big deal? Some dem is doing this to make the health care bill pass.
“‘On a diet of strictly breast milk,’
The best recipe in the world.”
*****************************************************************************
I could not agree more........Some mother say for the first two years too!!!!!
I agree the article is suspect. Gov regs make insurance a mess. More will only make it worse.
My son was something like the 95th percentile (breast fed) up until 9 mos. At that point I stopped breast feeding. He didn’t gain any more weight until he was about 3 years old - just got taller. At 30+ he is still slender with a high metabolism. Chunky babies aren’t exactly a precursor to overweight adults - especially not breast fed babies.
Same with my son, he was breast fed early. Then peaked in weight around 6 months and just grew taller after that for years. Had a fat ratio test (or whatever it is called) in high school for wrestling so they could decide if he could drop weight and wrestle lighter, and he had only 4% body fat.
My son was like that.. big ol breastfed baby. He was wearing 2T outfits at that age. All my babies grew out of that baby chubbiness after they weaned. It was so cute while it lasted.
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