If four-month-olds are being denied health insurance coverage, is anything sacred?
Filed under: Insurance, Kids and Money, Health, Insurance-health
In yet one more reason why the national dialog has changed from "health care reform" to "health insurance reform," Grand Junction, Colo. native Alex Lange was denied insurance coverage by Rocky Mountain Health Plans. Lange has never smoked, drank alcohol, nor has he ever been diagnosed with a chronic disease. In fact, he's only been to the doctor a few times for checkups, and has never missed a day of school or work in his life.
That impressive track record can be credited to the fact that Alex is just four months old and, in his short life, he has been fed nothing but breast milk. Nevertheless, he was denied health coverage because, according to growth charts, he's obese.
Alex's dad, Bernie Lange, is a part-time anchor on local news station KKCO-TV, and he recently went public with his family's denial. As Dr. Doug Speedie, medical director at Rocky Mountain Health told the Denver Post, "If health care reform occurs, underwriting will go away. We do it because everybody else in the industry does it."
After the news broke, however, Rocky Mountain Health issued a press release that said it has reversed its position and corrected its underwriting guidelines and "will now provide health plan coverage for healthy infants, regardless of their weight."
This case seems evidence enough of why health insurance needs to be reformed and tighter restrictions need to be placed on insurers' ability to deny coverage. If a baby has to lose weight before he can qualify, is anything sacred? Pediatricians routinely tell parents of breastfed babies not to worry about how their child's weight gain looks on the growth charts. After all, those that the CDC maintains are based on formula-fed babies whose growth curves are often quite different than those of breast-fed babies. My own three children were rated morbidly obese thanks to these charts and they weren't even a bit roly-poly, often slipping out of their baby pants because of insufficiently hearty bottoms.
Certainly, families can not alter the genetic makeup of their babies -- nor should they change a baby's doctor-recommended diet, letting him go hungry in order to drop a few pounds. The risk-averse approach to health insurance coverage ends up leaving families out in the streets, for no reason other than a company's fear of having to pay for that family to live healthily, and free of the crushing weight of medical debts.
It's a clear result of the mindlessness of actuarial tables and insidious in its undercurrent of selectivity. Rationing health care? We've got it right here. Only the healthy (according to the obviously insufficient charts) have any right to health.
That impressive track record can be credited to the fact that Alex is just four months old and, in his short life, he has been fed nothing but breast milk. Nevertheless, he was denied health coverage because, according to growth charts, he's obese.
Alex's dad, Bernie Lange, is a part-time anchor on local news station KKCO-TV, and he recently went public with his family's denial. As Dr. Doug Speedie, medical director at Rocky Mountain Health told the Denver Post, "If health care reform occurs, underwriting will go away. We do it because everybody else in the industry does it."
After the news broke, however, Rocky Mountain Health issued a press release that said it has reversed its position and corrected its underwriting guidelines and "will now provide health plan coverage for healthy infants, regardless of their weight."
This case seems evidence enough of why health insurance needs to be reformed and tighter restrictions need to be placed on insurers' ability to deny coverage. If a baby has to lose weight before he can qualify, is anything sacred? Pediatricians routinely tell parents of breastfed babies not to worry about how their child's weight gain looks on the growth charts. After all, those that the CDC maintains are based on formula-fed babies whose growth curves are often quite different than those of breast-fed babies. My own three children were rated morbidly obese thanks to these charts and they weren't even a bit roly-poly, often slipping out of their baby pants because of insufficiently hearty bottoms.
Certainly, families can not alter the genetic makeup of their babies -- nor should they change a baby's doctor-recommended diet, letting him go hungry in order to drop a few pounds. The risk-averse approach to health insurance coverage ends up leaving families out in the streets, for no reason other than a company's fear of having to pay for that family to live healthily, and free of the crushing weight of medical debts.
It's a clear result of the mindlessness of actuarial tables and insidious in its undercurrent of selectivity. Rationing health care? We've got it right here. Only the healthy (according to the obviously insufficient charts) have any right to health.



Reader Comments (Page 1 of 12)
10-12-2009 @ 6:02PM
ACrowley said...
My daughter, Meg, 11, has been denied health coverage since she was six. She has asthma which is managed by meds and we haven't had a true flare up in a couple of years, however, still we are left with NO options. Everytime we apply for a new coverage they either deny her, offer hospitalization insurance only with a 10,000 deductible and her premiums are $600/mo, or refer us to the risk pool which is about $650/mo for her. Her meds alone are 350/mo. Who can afford that? We make too much money to qualify for any type of assistance but after all her (and my) medical bills every year we would do better closing our business and taking welfare! There should be an affordable solution for children! I have health issues as well and since my husband lost his job six years ago, I am also uninsurable. I just got in trouble for not buying meds I need that cost $300 for 8 pills. I don't know what to do! Something needs to change! I have struggled for years with this problem and I am only 35.
Reply
10-13-2009 @ 9:20AM
Lynn2 said...
I agree with you. I have said for years that the people who are against health care/insurance reform are the healthy ones, or the ones who have money to pay for care and or insurance. the rest of us that actually have problems get denied. We are in the same boat as you. We work and our income is too high for help, (we are only considered lower middle class), but our premiums are $50 a visit to see a doctor. I pay over $350 a month for our prescripltions, (3 of us have chronic allergies & take medicine year round), and any hospitalization requires us to pay a $10,000 family co-pay. My son had surgery when he was 4 yrs old, we just finished paying off the co-pay last year when he turned 9! I have needed surgery for years but cannot afford the co-pay. The story is the same...rich folks pay for it & the poor get it free. Only us dummies who are middle class get screwed.
10-13-2009 @ 10:27AM
bobby said...
It is people like you that make it almost impossible to afford health ins. in this country. I'm sorry your little girl has asthma, but you just said she hasn't had a case in years. Why the 4000 dollars a year just for her meds. And if you are only 35 with all of these problems maybe you should consider a more healthy lifestyle. Asthma is not a decline in underwriting maybe a rider. Sorry I don't believe your story.
10-13-2009 @ 10:54AM
Lisa said...
bobby, her meds are what keep her from having a flare-up. Asthma is a chonric disease with no cure--once you've got it, you're stuck with it for the rest of your life. There may be times in your life when it doesn't bother you at all for a few years, and then suddenly it's back to its old tricks again. I'm an asthamatic who is fortunate enough to have insurance, but I can barely afford the medication even though the insurance pays most of the cost! Mine's mild enough that it doesn't cause much trouble unless I have a cold or flu, but it still acts up during allergy season. The idea of most asthma medications nowadays are PREVENTION. But unfortunately, these preventative medications--which keep children like this child out of the hospital and from ending up with thousands of dollars of hospital bills--aren't cheap. I'm pretty sure one of my medications cost about $200 without insurance. And thanks to the EPA forcing a change in abuterol inhalers (which is a RESCUE inhaler that ALL asthamatics need), they can no longer be bought generically.
10-13-2009 @ 11:22AM
Jodi said...
My family spends $808 a month on health insurance not including co-pays and medications. ( medications are $450 a month and co-pays vary but are around $350 a month) We have to pay this because my husband makes to much money for us to get any state aid. We have 3 children 1st is 7 years old she is autisic and has fontal lobe syndrome. 2nd is 5 years old she has to have O2 on most of the time she has to wear a SPO2 monitor to conferm that her O2 levels are high enough. She also has an enlarged heart and seizures. Our 3rd child does not have any heath issues. This is not a life style issue. We just had bad luck with in the draw. I did not do anything different with each child. I had the same doctor in all three pregnancies. I did not and do nor smoke, drink, take street drugs or drink caffine because of the possible effects that it could have on the fetus. We are having to pay the high insurance cost but it could be worse we could be with out insurance. Our insurance company as of October 1st had paid out $350,000 that is not claims, that is pay out for this year alone. We have no choices anymore if my husband were to loss his job we would be homeless with no insurance within 2 months. This is not far and something should be done about it.
10-13-2009 @ 12:57PM
reidgator said...
Recently, VP Joe Biden said (paraphrasing), "It is time we all got used to the idea of a nuclear Iran."
In the same sense, maybe it is time we all accepted the fact that our technology has exceeded our resources. While we have discovered and developed capabilities to repair & heal all sorts of medical conditions, the cost is simply too much.
Suppose the cure for AIDS was to live on the Space Station for 6-months, at a cost of $20 million per person. With 500,000 people in the USA with HIV/AIDS, that would be $10 trillion dollars. The USA's annual GNP is not much more than that. Could we afford to spend all of our resources on ~0.1% of the population? If the cost was only $2 million person, now, that would only be 10% of our GNP. So, yes we COULD!! But, WOULD we?
Let's be honest - we do not have the RIGHT to live forever. We do not have the RIGHT to be repaired and healed of our afflictions. Life is not fair. I am not being callous. I am simply being honest. Some may say, "But what about the children?" OK - what about them? What about the those adults who can not have children? Is that fair to them? How much are we willing to spend to solve/cure their infertility? Do those adults have the RIGHT to be parents??
Again, we need to accept some realities. The cost of health is EXPENSIVE. There are wondrous things that we have learned to do with science. But - they are EXPENSIVE. And no legislative or executive decree is going to change that reality!!
10-13-2009 @ 1:06PM
reidgator said...
Another thought... some of you believe that a "national health care program" AKA, "socialized medicine" is the solution to these problems. WRONG!! The reason that you have to wait in Canada and other countries is because they RATION their health care. Norwegian officials flat out declare it. They have stated that they will not spend 80% of their health care resources on 20% of the population!
They engage in what could be called "financial triage". If the cost is high and chances of success are low, they simply refuse to treat you. In China, if you are a smoker and you develop ling cancer, they make little attempt to heal you. They will try to ease your discomfort, but, they will let you die.
If your condition is not serious, they will hold off treatment in hopes you'll learn to cope, or travel to the USA to pay for your won treatment. (Ask the Canadians!)
These other countries have accepted the reality. It is time we did too!!
10-13-2009 @ 1:32PM
k said...
Bobby, you want her to change her lifestyle? A lot of diseases (like autoimmune conditions and cancers) can strike people of any age regardless of lifestyle.
At age 15, I developed a life-threatening autoimmune condition. I was of normal weight, ate a balanced diet with lots of fruits and vegetables, and exercised regularly. I did not smoke nor was I sexually active - in other words, I was not engaging in any risk factors associated with SOME diseases. I had no other health issues before this struck me totally out of the blue and completely changed my life. I've almost died three times and now take about 5 maintenance medications per month at $15/each. I have weekly labwork at $20/each. I have at least 1-2 doctor's appts per month at $20/each on top of paying my regular premium of about $100/week. I also have to pay back $1200 for tests that were not covered by my insurance because my annual deductible is $2000 (fortunately, the hospital is allowing me to pay this off at $60/month).
Before you accuse this poor woman of not taking care of herself, please educate yourself. She could have inherited or acquired something through no fault of her own.
All of the people who say that health reform is not needed...y'all are very lucky that you aren't sick. Just wait until this happens to you and then you may finally understand why so many of us are so p**sed off with the current system.
10-13-2009 @ 8:22PM
jj said...
Easy, DIVORCE your worthless husband who hasnt worked in 6 YEARS. Sell your business and get on medicaide. Single mom who earns less than 1,200 a month=100% covered for food stamps, medical, welfare money (for 2 years). Then go after your husaband for child support, because it sounds like he supports nothing at the moment.
10-13-2009 @ 9:29PM
kelly said...
You state that your daughter's meds cost $350 which means that you are asking the insurance company to assume guaranteed costs of $350 a month plus the chance that she will need additional care. A $600 a month premium breaks down into $350 for medication and then $250 a month to cover the risk to the company that your child will need other medical care. Since your child has a chronic disease, that $250 a month for insurance sounds pretty cheap to me.
Why would an insurance company EVER write a policy where it is guaranteed that they will lose money on the policy? The pool of funds that policyholders pay into the insurance company is the only money that the company has to use to pay the healthcare costs of all of its policyholders.
You've stated that a government run pool is available for your daughter, but you have chosen not to use it. You are not looking for insurance for your child. You are looking for a handout. You want other people to pay for the healthcare costs of your child and that simply is not fair.
Your child's health should be a high priority for you. Perhaps you need to downsize your lifestyle so that you can afford to care for your child. And don't state that you cannot get health insurance for your child. The fact is that insurance is available but you have chosen to not insure your child so that you have more money to spend on other things.
I also have chronic conditions and I pay 20 times more each month on health care than I do on entertainment. I don't expect others to pay for my health care so that I can go out more often.
We don't need national health care. We need Americans to stop expecting constant handouts.
10-13-2009 @ 9:27PM
TAMI said...
try disability at the SS!! I know a teen who gets it and medicare because of her asthma...it will be awhile before health care is resolved...so try for that in the meantime...she is unable to have the quality of life a normal person has..she is disabled..it isn't about "working"....
10-13-2009 @ 10:54PM
Ryan said...
I find it interesting that NO WHERE in the article does it actually tell the childs weight. If it is SO obese that it is unlikely to survive...i understand the decision. This seems like an article the media puts out just to get peoples blood boiling about all this heathcare reform
10-13-2009 @ 11:04PM
suealiaim said...
lynn2 - i agree...but would add that those who oppose reform have never had to USE their insurance for anything more than a runny nose and have NO CLUE what medical care costs - even when one HAS insurance...
10-13-2009 @ 11:16PM
jim d said...
$300 for 8 pills, i'm a paramedic and from a clinical standpoint and just general curiousity would be interested in knowing
what med costs that much
10-27-2009 @ 12:06PM
MARISSA A. said...
I live in NY and my husband and I are both on Medicaid; I am a Full Time college student and he works as a truck driver. He earns about 500/wk, give or take 50 or so, and our four kids are on Medicaid. We lived in Texas and Florida and NY is by far the best. In Florida, we paid for health ins. and it was ok, but doctor's visits were $20 and prescriptions were $20. In TX, we had no ins. of any kind, and paid thousands for dental, and I had to use a clinic for dr.'s visits; $100 one time to get diagnosed w/ a UTI! Then paid the Rx cash. Root canals; I paid for two, and crowns on top, then ran out of money for me. My kids needed fillings, X-rays, etc: all out of pocket. TX has no dental ins. at all for poor kids. Here in NY the kids go to the dr. and dentist free; Rx's are free. My daughter's asthma meds are over $400/mo: paid in full by Medicaid. No co-pays. Dentist visits, X-rays, fillings, free. My husband and I see the dr. $5 a visit. Dentist $5 a visit; some things cost a little; a root canal was $450. The Medicaid paid for my daughter's nebulizer, her inhalers, her monthly Advair and Singulair, everything: FREE.
10-17-2009 @ 8:03PM
Heather said...
While healthcare reform may need to happen, I have yet to see where the government getting control helped anything. We already know that Social Security is at risk. The estimated cost of cash for clunkers far exceeded expectation. The consumer is always the best at making or braking companies. I don't think we should have bailed out all the companies that managed themselves poorly. Why pour more money into a company that didn't do their job in the first place. I feel for your situations, also, I know that there are options in some places. I know many drug companies have coupons and help for people who can't afford their medicines. I also know Costco has a much lower mark-up on medications than many companies. I know it has to be frustrating, but I just can't help but think turning to the government is not the answer. My cousin just had brain surgery and the hospital wrote it off because she didn't have insurance. It may depend on where you are or who you talk to, but good is out there.
Reply
10-12-2009 @ 11:06PM
Jeannette said...
Heather, the problem is that with no one overseeing the entire system, corruption is everywhere. Sure, there is good out there, but shouldn't we have a system available that is reliable and doesn't require jumping through hoops to get what is needed? People who are wiling and able to pay for their health care should be able to count on it being there when it is needed. The problem with health insurance for profit is that it is NEVER in their best interest to pay a claim, so it makes perfect sense for them to try to deny every claim. The system needs to be turned around! In a not for profit system, the impetus could be placed on good care rather on profits. In my view, this by definition must be better. After all, it is basic common sense that people will act according to what their best interests are. If a company is rewarded for making money.....well then, that will always be their overriding goal.
10-13-2009 @ 9:55AM
bob said...
Your cousin had surgery and they wrote off the cost? Who do you think ultimately foot the bill for that? YOU AND I! (the government) they wrote it off because they knew they would never get their money, and the gov. will subsidize them for their loss. sorry, your argument does not hold water
10-13-2009 @ 1:39PM
Elentari said...
@willer: "and why should i have to pay for it for someone that is too stupid/lazy/fat/etc. to try to get a job to get their own insurance?"
Guess what, genius. Most business in this country are small businesses whose owners can't afford to subsidize health insurance for their employees. And they don't pay wages high enough for people to "get their own insurance." "Too stupid, lazy, fat" to get a job? Wow, you must live in Oz or somewhere over the rainbow where the economy is great and jobs are plentiful. Can you idiots not see farther than your own *icks that you can't understand that people need help? If the management of big corporations was not so greed-based, more people in this country could have a better life. THINK!!! instead of blindly believing (and repeating) what your lunatic, unpatriotic, treasonous, conservative gurus tell you.
10-13-2009 @ 2:47PM
reidgator said...
Responding to elantary's sophomoric rant:
You wrote: "instead of blindly believing (and repeating) what your lunatic, unpatriotic, treasonous, conservative gurus tell you."
It is people like YOU who are blindly believing the propaganda. These insurance companies that you deride are essentially your fellow citizens. When you file a claim, the cost is not born by some rich smuck with unlimited financial resources. WE, your fellow citizens, bear that cost. Insurance companies are "collectives". We pool our resources together and we pay the insurance company a portion of those premiums to manage those resources.
That does not mean they always make the right decisions. That does not mean that they can not be greedy.
But - when YOU demand that OTHER CITIZENS pay for YOUR health care, aren't YOU being the greedy person??? Liberal idiots like you believe that resources grow on trees and that there is an umlimited supply.
You remind me of the story of the goose that laid golden eggs. You are not content with one egg a day. You demand more and more. And when the goose delivers only one egg a day, YOU accuse the goose of being greedy! Yet - it is YOU who is greedy!
Do you want to know who is truly responsible for YOUR health care? Look in the mirror!
It is clear that your intellectual abilities are limited, so let me offer an illustration. Contrary to liberal philosophies, you are not entitled to a public education, nor a diploma. We, the taxpayers/citizens, have decided that we will offer you an educational OPPORTUNITY at our expense. However, that offer carries some responsibilities. You have to show up in class and behave yourself. (There are OTHER students as well!) If you fail to behave, you can be kicked out of school. More importantly, you have to do the work. You have to study! In short, whether or not you get an education, is up to YOU. It is YOUR responsibility.
What you are NOT entitled to is:
- an eduation at the most expensive private schools
- the same education as the rich
- good grades (you have to earn them)
Is it fair that a poor child can not afford to go to the same school as the rich child? Is it fair that some children are blessed wih more intellectual capabilities than others Nope, but, that is the way of life.
The same applies to health care. You make choices and do your best and accept what life brings you. You are not entitled to ANYTHING at someone else's expense.