A heavy baby’s pre-existing condition

A HEAVY BABY’S PRE-EXISTING CONDITION…. In the midst of a major, national debate over health care reform, and the role private insurers play in proving coverage for millions of American families, you’d think the insurance companies would try to put their best foot forward. The same insurers that want to rally opposition to a public option should, in theory, be on their best behavior.

That would generally not include denying coverage to an infant because he was deemed too heavy.

Imagine having a perfectly healthy two month old baby and having your insurance company tell you they won’t cover him. One [Grand Junction, Colo.] family says that’s what’s happened to them.

Baby Alex is a happy, adorable, big baby. And now at three months old, the family’s insurance company says he’s not eligible for coverage.

Alex eats well, is growing fast and has no pre-existing conditions. But his mom Kelli says their insurance company says he’s just too big. “Insurance standards say if he’s above 95 percent he’s uninsurable.”

Because of his size, Alex was turned down for health insurance, his height and weight put him in the 99th percentile according to CDC guidelines.

The baby is healthy, but is nevertheless considered “obese.” The insurance company said “a number has to be used as a cutoff,” so Alex was out of luck, through no fault of his own.

The baby’s father added, “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. There is just something absurd about denying an infant.”

Late yesterday, Rocky Mountain Health Plans, embarrassed by the publicity, reversed course. Baby Alex will not only be covered, by the insurer has said it will correct “a flaw in our underwriting system for approving infants.”

Realistically, the change was the result of media attention and a compelling human-interest story. But here’s the angle for members of Congress to consider while weighing the future of health care reform: plenty of families who aren’t media savvy are getting screwed by insurance companies every day, and insurers aren’t backpedaling because no one hears about the scandals.