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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