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4 month old baby denied health insurance

by grimgraphix / October 14, 2009 1:26 PM PDT

Rocky Mountain Health Insurance has denied health coverage to a 4 month old baby because the child is above the 95th percentile on their actuary charts. Other than his large size, the baby is recognized as being perfectly healthy... but just big. The baby has been breast fed for his whole life, and pictures I have seen do not show any signs of obesity.

The insurance company later reversed it's decision after the story broke on TV. I guess the company didn't realize the child's father was a reporter-anchor for a local TV station.

Meanwhile... the debate about whether US health care insurance really needs to be supplemented or rebuilt by the Fed goes on....

http://rawstory.com/2009/10/after-denying-infant-coverage-insurer-says-they-will-cover-heavy-babies/

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good for them
by James Denison / October 14, 2009 1:29 PM PDT

They quickly reacted to the error and responded appropriately. Try getting any govt program to respond that quickly.

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James, they only changed when exposed on TV
by grimgraphix / October 14, 2009 1:35 PM PDT
In reply to: good for them

The whole story isn't fully reported yet so I will withhold my judgment about just how quickly they changed their tune.

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If one persons mind is changed
by Steven Haninger / October 14, 2009 6:52 PM PDT

after being threatened, another person is usually guilty of some likeness to extortion. Happy

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Were they threatened...
by EdHannigan / October 14, 2009 11:16 PM PDT

Or did someone just point out their error?

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Were they threatened ?
by grimgraphix / October 15, 2009 7:14 AM PDT

Is revealing a companies' policy on TV, by definition a "threat" ?

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Uh...no.
by EdHannigan / October 15, 2009 7:33 AM PDT
In reply to: Were they threatened ?

Do you think it is? You are assuming that that is what made them change the policy.

Back to the other poster you so rudely castigated... if the government made a similar mistake, how long do you think it would take them to correct it, if they did?

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I will point this out again...
by grimgraphix / October 15, 2009 8:09 AM PDT
In reply to: Uh...no.

... that that question had nothing to do with the post the individual attached it to, where I said the TV news appears to have had an influence upon the insurance companies' change of heart.

I did not state that I think government should take over health care did I? I said Meanwhile... the debate about whether US health care insurance really needs to be supplemented or rebuilt by the Fed goes on....

Health care is an exclusive club, available to a select community of privileged people in the US. Do you find it reasonable that some citizens are excluded from being able to get health care insurance, even if they are willing to pay for it?

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Since the post was deleted..
by EdHannigan / October 15, 2009 8:22 AM PDT

there's no way to tell for sure, but at the time I thought it was directly relevant. Would the TV news have had an influence on the government if they were in charge (which is part of what the debate is all about)? The Admin has declared all out war on insurance companies and wittingly or unwittingly, you were taking a side in that war.

I think that companies should have the right to NOT cover high risk people if they so choose, or to impose certain rules. Otherwise, they are out of business. But, I guess that's the goal.

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re: no way to tell for sure
by grimgraphix / October 15, 2009 8:40 AM PDT

try this... read my post.

James, they only changed when exposed on TV
by grimgraphix - 10/14/09 8:35 PM
In reply to: good for them by James Denison

The whole story isn't fully reported yet so I will withhold my judgment about just how quickly they changed their tune.


... and tell me exactly where my comment is related to the government?

Do I think insurance companies should have the right to choose who they cover? Certainly, but only if there is a competitive marketplace. The reality is that there is no competitive marketplace since affordable US health care is primarily available only to your job because only large companies have the negotiating power to purchase affordable care.

Adequate health care is a luxury priced necessity. Advanced health care is an astronomically priced necessity. The moral and ethical question is, should it be?

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That's not the post I was referring to.
by EdHannigan / October 15, 2009 8:48 AM PDT

The one was talking about has been deleted.

I stand by my statements

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yeah, their post and my response were deleted
by grimgraphix / October 15, 2009 9:01 AM PDT

They threw out a non relevant "what if" question... and I said it was nonsensical in the context and to stick to the point.

You do love tenderizing horse meat.

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Run to the press...run to the press
by Steven Haninger / October 15, 2009 7:59 AM PDT
In reply to: Were they threatened ?

It's not the revelation of policy that's a threat so much as the fear of what the spin doctors do with it. Yes, it's a threatening thing to do...a lose-lose situation.

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I'm not convinced.
by EdHannigan / October 15, 2009 8:07 AM PDT

"A recent situation in which we denied coverage to a heavy, yet healthy, infant brought to our attention a flaw in our underwriting system for approving infants," Steve ErkenBrack, president of the insurer said in a release Monday. "Because we are a small company dedicated to the people of Colorado, we are pleased to be in a position to act quickly. We have changed our policy, corrected our underwriting guidelines and are working to notify the parents of the infant who we earlier denied."
_______________________

Who is to say they didn't just look at the situation and realize they had made a mistake?

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Threatening? maybe but
by Roger NC / October 15, 2009 8:17 AM PDT

given how much power the insurance has compared to an individual, I'd call it evening the odds to make the company at least look at your case.

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I'll admit it's cynical
by Roger NC / October 15, 2009 8:06 AM PDT
In reply to: good for them

but it does remind me of how often you see on local tv news a story about someone that can't get a reply or settlement from some organization.

Usually right after the story makes the evening local news, someone "wakes up", calls the person complaining, and is all helpful about how their case got lost in the system.

Sometimes someone has spent months trying to settle a dispute with little or no co-operation from the other party. But once the evening news makes a story out of it, it was all a misunderstanding.

And besides, how the heck can you deny coverage for "preexisting conditions" in a 4 month old baby. The parents were shopping for new insurance because theirs went up 40% when they had the kid. It isn't like they had a baby, found out it had a health problem, then tried to buy insurance for the first time. Besides, kids can change so much in the first 2 years that a weight/height(length) ratio in the first few months means almost nothing.

That goes back to another thread where I voiced the opinion that if you have insurance and just want to change policies, carriers, or jobs, the new insurance should not be allowed to deny you coverage for pre-existing conditions as far as ones you're already having treated. It might be one thing if you're trying to buy insurance when you have none after you find out you're sick. But insurance rules shouldn't discourage people from changing insurance companies or make it difficult for them to change jobs.

At the best, it's another case of blindly accepting statistics and making rules without thinking about possible reasons the rules will be wrong. At the more likely, it's total indifference to people and just denying coverage to anyone that may cost a dollar.

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My youngest was in the 95th percentile for years
by Diana Forum moderator / October 14, 2009 11:05 PM PDT

and not fat - just big and strong.

Diana

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Mine too, all through his childhood, now he's 6'3", 22 yoa.
by Ziks511 / October 18, 2009 1:55 AM PDT

and outside of a hernia at age 18 months (linked to his tallness) and a tonsilectomy 3 years later, he's had no health problems.

Rob

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The larger implication... pardon the pun...
by grimgraphix / October 15, 2009 7:57 AM PDT

The larger implication is that the companies' policy of not insuring babies larger that the 95 percentile is that this company will not insure 5 % of the children whose parents seek coverage for.

Forget about "death panels" deciding end of life health care availability. Let us discuss companies that refuse children a starting chance.

http://www.examiner.com/x-8543-SF-Health-News-Examiner~y2009m10d12-Fat-baby-No-insurance

Rocky Mountain Health Plans has now said it will cover Alex Lange, a baby they previously refused to give health insurance because of his weight. "A recent situation in which we denied coverage to a heavy, yet healthy, infant brought to our attention a flaw in our underwriting system for approving infants," says Steve ErkenBrack, president and CEO, Rocky Mountain Health Plans.


"we denied coverage to a heavy, yet healthy infant"...

The fact is that insurance companies simply don't want to insure unhealthy people. Who can blame them? After all, medicine is know a business. Let business ethics replace medical ethics. Yeah, that's the ticket.

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Not just one insurance
by Roger NC / October 15, 2009 8:23 AM PDT

company it seems.

Reading around, it seems to be a standard

The Denver Post writes that insurance companies don't accept babies for coverage if they are even in the 95th percentile for height and weight. The same goes true for adults who have a body-mass index of 30 and above. Speedie mentioned that some babies who weigh less than Alex have to get health endorsements from their doctors to qualify for coverage.


Let's see, if all the obese just die off, and over 10% of Americans are considered obese, that should help reduce health care costs. Also reduce the unemployment rate, welfare cost, and overpopulation problems.

Now if we deny a couple more groups care, smokers? drinkers? diabetics? cancer patients?

Deny a couple of those along with fat people and the insurance companies should do just fine financially and or national health care cost should go down. And just look at the (temporary) huge increase of jobs as gravediggers.

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A quibble ...
by Bill Osler / October 15, 2009 8:55 AM PDT
The fact is that insurance companies simply don't want to insure unhealthy people. Who can blame them? After all, medicine is know a business. Let business ethics replace medical ethics.

Medicine has always been both a business and a profession ... but that is NOT relevant to your post. The issue here is that INSURANCE is a business. Medical ethics are completely irrelevant to the business of providing insurance.

I can't say that I've encountered this situation before, nor would I consider it a given that an exclusively breast fed baby over 95th percentile for weight or BMI or whatever is at increased risk. The insurance company erred on many levels ... but their error never had anything to do with whether or not medicine is a business enterprise.
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is it 2 different things?
by grimgraphix / October 15, 2009 9:29 AM PDT
In reply to: A quibble ...

One business funds the bulk of the other, does it not? Indeed, insurance companies are given preferential pricing for procedures and general treatment versus patients who pay out of pocket.

I have worked in medical and mental health clinics. I coordinated in home treatment services for patients, and was told to cut back or discontinue services for patients based on their state, federal and insurance coverage as well as their state of health. Some of these patients then experienced an increase in hospitalizations.

I can see your distinction. I can also concede that this child would probably have received treatment if needed, despite not having insurance. I would hope that you can concede that the kind and quality of medical treatment is often influenced by money, and that the best choice for the patient is sometimes secondary to the cost of services.

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EVERYTHING depends on money ...
by Bill Osler / October 15, 2009 10:47 AM PDT

It's not just healthcare where money influences decisions. Have you never made grocery purchases based on cost? Or chosen a residence based on cost? I'd say that food and shelter are a bit higher on the list of life requirements than is medical care, yet I don't hear too many calls for universal grocery store rationing coupons or housing vouchers.

I find it a bit ironic that you are complaining about the fact that insurance coverage influences healthcare decisions. In countries that DO have universal coverage it is ultimately the government that makes those financial decisions. My experience has been that Medicare and Medicaid are FAR more rigid in their 'medical appropriateness' rules and coverage than ANY of the private insurers I have encountered, and it is generally harder for the patient and physician to find ways around the rules with those government programs than it is with private programs.

I can't speak to YOUR experience, nor can I comment on what happens in other places, but in my practice most of the financial choices are made by patients, based in part on whether or not their insurance company will pay. Sometimes my options are limited by finances (eg: if a specialist won't see an uninsured patient without an up-front payment the patient may choose not to schedule an appointment) but in the end those choices are generally made by patients, not by insurance companies. Even in other areas (physical therapy, ...) the patient generally has a choice.

I think we should be able to find a way to make health insurance available to all Americans, and that will change the details, but please don't pretend that universal health insurance will remove money from the healthcare decision making process. Rich people get better access to care than poor people for any number of reasons, not just insurance coverage, and that is true even in countries with universal coverage.

I can't comment on your experience, other than to note that in the situations you described the patient SHOULD have been given a choice to continue care whether or not it was covered. The list of options that a patient chooses from should NOT be determined by money even if the patient's choices are ultimately driven by money. Sometimes patients DO choose second-best treatments, but in the end that should be the patient's choice. That will be true whether or not the patient has insurance.

So yes, I do feel quite comfortable making a distinction between the ethics of medical practice and the business practices of insurance companies. I don't work for the insurance company.

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Was it really the patient's choice
by Diana Forum moderator / October 18, 2009 1:52 PM PDT

You were saying that the insurance company wouldn't pay for it or the specialist wouldn't take an uninsured patient without a large upfront fee. I'm sure the patient would love to have the care that his/her doctor prescribes but can't afford it.

We're not talking about the difference between a sports car or a Kia or between lobster or hamburger. We're talking about getting well or not dying.

Diana

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From an economic perspective ...
by Bill Osler / October 19, 2009 9:24 AM PDT

It is arguably ALWAYS the patient's choice because the patient has to decide how to allocate financial resources. I realize that is an oversimplification but there is a certain amount of validity to the perspective.

Regardless of whether you agree with me on that issue, I think the most important point is that no matter what system we end up with, people who have more money will get better health care because they have more options. Money will ALWAYS be an issue, regardless of insurance status.

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(NT) I agree about it being all about money
by Diana Forum moderator / October 19, 2009 12:56 PM PDT
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