The Flaws in Insurance Coverage

Written By: Lisa Matthys

Are insurance coverage requirements too specific? One family’s story may have insurance companies reevaluate their cutoffs for insurance coverage.

Alex Lange, son of Bernie and Kelli Lange, was denied insurance coverage by an insurance underwriter for Rocky Mountain Health Plus because their baby had a pre-existing health condition, obesity. When Bernie and Kelli went shopping for better premiums, they learned that their baby’s size matters.

At four months old, baby Alex weighs 17 pounds at 25 inches tall. Based on his height and weight, he is in the 99th percentile subject to obesity most likely due to breast-feeding and his great appetite.

No matter how healthy the infant, most insurers won’t cover a baby over the 95th percentile including Rocky Mountain Health Plus. But no parent is going to deny their child food just so they can remain within the 95th percentile. Dr. Doug Speedie, medical director at Rocky Mountain Health Plus, believes that it is possible for a baby to be above the 95th percentile and still be healthy, and admits that the system is flawed.

To many supporters, this story gives reason for health reform. In a highly profitable industry, insurance companies regularly deny coverage to people with pre-existing conditions that make them a financial risk. Aware of the flaws in the system, many health-care reformers are taking aim at the practice of underwriting. With current debates and lobbyists, the health-care system will most certainly experience changes over the next few years.

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