Baby too big for insurance coverage

By: Chiara Lotierzo Email
By: Chiara Lotierzo Email

Imagine having a perfectly healthy two month old baby and having your insurance company tell you they won't cover him. One local 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.

Kelli says it’s ridiculous, “It's frustrating, it's very frustrating."

Dr. Speedie at Rocky Mountain Health Plans says all babies are evaluated for insurance the same way. "In children it's based on a combination of height and weight."

But he says it’s also possible for a baby to be above the 95, or "cutoff" percentile, and still be healthy.

He says, “Your weight is not an absolute determinate of health." But says as with all insurance companies, the line has to be drawn somewhere. “Unfortunately when we try to sell people insurance, a number has to be used as a cutoff."

Speedie admits, even when it comes to adults, it's a flawed system, "It's a combination based on height, weight and a fudge factor."

But, he says they have to go on what works for the masses, not the individual, and says it's just one more reason his industry is leaning toward reform.

For a link to the CDC’s guidelines for babies and how to calculate your Body Mass Index, click the links below.


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Comments are posted from viewers like you and do not always reflect the views of this station.
  • by MariaR Location: Nevada on May 7, 2010 at 10:56 AM
    It is a real nonsense here. Insurance companies are so rude lately that it is really had to believe in it. I have heard many comedy - like situation but this one is the top for sure. If I would hear something like "your baby is too big..." I would go really mad. Sometimes I can't understand why do we need that insurance for sure. If they feel that some trouble can come up - they are denying an insurance for you. It is not normal at all. So if my baby is too big or too tall, I can't get any Family Vision Insurance Plans as I understood? I feel really sorry for kid's parents. However on the other hand, parents must keep their child healthy too. 99 percentiles is not good at all and it may make his future difficult. Visit the doctor or physician consultation and try to change something. Not because of insurance - just because of your child's future. Just be strong and everything will be fine.
  • by Barbara Location: Geneseo, NY on May 3, 2010 at 10:40 AM
    I am the grandmother of another big baby and would like to know how little Alex is doing today. My grandson is 16 lbs at 10 weeks of age. He is off the chart for weight and 50% for height. He is breast fed too. I would like to get in touch with Alex's parents to see how Alex is growing. Our baby's father comes from a very tall family (all 6 feet tall). First child is very tall but slim.
  • by Erick Location: Regina rhymes with, well, you know... on Nov 7, 2009 at 02:59 PM
    Our oldest daughter was in the 75th percentile, and she looked well-fed. I imagine those bigger kids are just that - bigger. What kind of coverage are we talking about here, anyway? Life insurance? Breastfed kids are supposed to be healthy since they're being fed the healthiest stuff possible (according to my doc, anyway). I think it stinks the way the newsguy went with his story AFTER the company changed its policy. It didn't change because of the newsstory, it changed because they were convinced changing it was the right thing to do. Insurance companies do it more often than it's reported. Even they realize it can't all be sweepingly changed, but they are working on it. Why aren't there more stories about insurance companies who change policies simply to update them to allign with current situations? Also, don't move here because even though it's free, it's not the best system I could think of being a part of. We visit relatives in Minot just so we can see their docs.
  • by Dana Location: Vancouver on Oct 22, 2009 at 08:13 AM
    My son was above the 97th percentile all through his baby time. He's now 19 months old and is in the 90th percentile. Fat babies are HEALTHY!! The pediatrician was fine with his weight. He is slowly losing his pudge as he runs around, but for heaven's sake, a 9 month old being obese? Give me a break.
  • by Liz Location: Victoria on Oct 21, 2009 at 03:44 PM
    My baby is 4 months old today and is above the 99th percentile. She is exclusively breastfed and is perfectly healthy. Unlike formula-fed babies, it is impossible to overfeed a breastfed baby. I'm glad I live in Canada where our health insurance system isn't so ignorant.
  • by Mike Location: Hayward Ca on Oct 20, 2009 at 02:06 PM
    How in the hell can you deniel a baby health care? Well if obama gets his way that will be happening more and more .This is a perfect Exampleof why we don't need a government run health care Program
  • by T Location: New Hampshire on Oct 15, 2009 at 03:18 PM
    A baby's weight at 4 months old has no relation to how much they will weigh when they're older! When my son was 4 months old, he was in the 99th percentile, as well. Now he is almost three and he is in the 50th percentile! (Which is average)Chubby babies are usually cuter than the average size babies anyway :-D
  • by louis Location: illinois on Oct 15, 2009 at 01:39 PM
    As a parent of a similar child... please if you can reach the parents have them check out the web site listed JUST IN CASE Their child has the same condition (our child went undiagnosed for three years).. it is a distinct possibility! Their baby looks like a possible Prader-Willi baby... http://www.pwsausa.org/
  • by Lyn Location: Grand Junction on Oct 14, 2009 at 07:27 AM
    Re: Danny Location Baton Rouge, Louisiana - as you can see by the post from M Location Grand Junction Rocky Mtn changed the policy BEFORE this media hype. It is VERY clear since you don't live here you don't know what this company does for Colorado. As far as having an employer standing behind you - they thought it was news worthy even though the problem had been solved - AGAIN you don't know Western Colorado - news must have been slow that day!!
  • by kim Location: san jose,ca on Oct 14, 2009 at 06:21 AM
    Baby, only in America, Baby !!!!
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