Tuesday, October 13, 2009

Four month old baby denied coverage for being "too chubby"

Alex Lange is just like any other infant in Colorado. He's healthy and he's breastfed. He's also a good size -- 17 lbs. Alex's weight, though heavier than normal, isn't anything to worry about. It puts him in the 99th percentile in terms of infant weight, but he can't do much about it, being that he's on a diet of breast milk and breast milk only.

Still, his weight has caused his parents much concern. Not because they feared their baby was obese, but rather because his insurance provider refused to cover him because of it.

Alex's insurance provider, Rocky Mountain Health Plans, only covered infants in the 95th percentile and lower with regards to their weight. Alex, therefore, was a prime candidate for being denied his insurance claims.

As was previously mentioned, Alex couldn't do much about this -- his diet consisted solely of breast milk. Most doctors recommend to mothers that they feed their child only breast milk in the early months of their lives. Alex couldn't go on a special diet to lower his weight, and being four months old he couldn't exactly get on a gym membership plan to shed those extra pounds.

So while Alex needed to see the doctor every few weeks or so, as every newborn does, his parents had to figure out a way to pay for all those visits as Rocky Mountain Health Plans had no intention to do so...until they buckled under media pressure from the event. Now Alex -- and all infants in his weight class -- can get insurance from that provider.

Alex's example is but a single instance within millions who find themselves being denied coverage by insurance companies for pre-existing conditions. Alex's case was quite unusual, however, in that, in a very short lifespan, he already had a pre-existing condition that was used to deny him coverage. Of all the people that his provider could deny, they chose a four month old infant, a patient that arguably needs more care than any other patient within their clientele.

What were Alex's parents supposed to do? When Alex got hungry, were they to say, "Not now Alex; we can't afford to feed you until you lose some weight"? Infants need to be fed several times a day, no matter what their weight is. But because Alex and his parents adhered to advice their doctor gave them -- advice that most every doctor will give in 99 percent of all cases -- his insurance company refused him coverage.

How is this fair? How is this American? Despite the happy ending, I'm not satisfied. I don't usually say that insurance companies are heartless corporations; for the most part, people who work for these companies are good people, and truly want to help the people they serve. But what else could you call this? What else could you cal an act so insensitive to the needs of a being so fragile?

It boggles the mind how one can be against health care reform, especially after hearing stories like this. Republican leaders, moreover, are doing little to help everyday Americans. House Minority Whip Eric Cantor recently suggested to a woman needing money for her health concerns to seek out a current government option (how ironic) or to seek out a charity to help her.

That plan, frankly, won't cut it: Americans need more than a charity to help them keep up with the rising costs of health care, now above $15,000 per year for a family of four. If they're paying for insurance, they ought to receive it, too. An economically viable plan should also be made available to those who can't afford private plans -- a public option to compete with the profit-seeking private insurers.

Maybe then people like Alex Lange won't have to wonder how to shed that "baby fat" in order to be covered by their employer.

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