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Wednesday, February 10, 2010

Child Too Small For Health Insurance: What Next? You're Too Tall, Too Short, Too Skinny, Too Fat?

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As a mother of an eight year who often gets confused as a kindergartner, reading the news released today of a two year old insurance has denied to cover because she is too small is rather frightening.

Wednesday morning "The Today Show" covered the story of 2-year-old Aislin Bates. With a weight of 22 pounds and in the 3rd percentile of children her age, United Health Care has decided to deny this child insurance. They claim she doesn't meet height and weight requirements of others her age. Her doctor has described her as perfectly healthy; never having been sick with anything more than a cold. [via Yahoo News ]

NBC's medical expert Dr. Nancy Snyderman was more pointed in her criticism: “This is just so bogus. A pre-existing condition for a child this age is birth, let’s be real..... This is why things have to change."

Just last month my daughter and I went for her yearly well check up and learned she is in the 5th percentile of her age group. She's always been small and our doctors have said this is due to us, her parents, being small also. Could she be denied on our next re-up with these companies (and that's what they are: for profit companies)? Will her premium be raised due to this newest addition to what is thought of as a pre-existing condition?

This is enough of health care and their bogus claims of pre-existing conditions. This is the way they get around having to pay for much at all. They can charge astronomical amounts of money a month for coverage and when it's time for them to pay the bill for coverage of routine check ups and doctor's visits because of a colds, they wimp out. In turn, you are denied because of some new addendum to their insurance policy handbook.

So many people are against a universal health care system but the need for legitimate reasons behind the denying of coverage needs to be addressed.

I would love to hear some feedback from those in the insurance industry. Why are these reasons the way they are and do they change on a case by case basis or does it just seem this way? PM
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Comments 1-2 of 2
  • elena's Avatar
    Posted by elena Thu Oct 22, 2009 1:06pm PDT

    I work for an independent insurance agency that sells all of the major insurance plans(Humana, Aetna, United HEalth Care, BCBS) to individual and small groups. That is a commom occurence, it didn't shock me at all. People are declined all of the time for benign reasons and I've seen it all, from being under/overweight, to taking depression/anxiety/ADHD meds or going to counseling, to having High Blood Pressure and High Cholesterol, which most people(men) over 50 have. United Health Care's decision to grant coverage was only because of the media attention, they would not have changed their minds otherwise. On my Humana application I ACCIDENTALLY checked YES to one of the questions and even after my doctor sent a letter and documents supporting my healthiness, Humana still decided to decline me just because of that simple mistake. Appeals never go in favor of the applicant and the underwriters always choose to decline rather than offer coverage if anyone isn't up to their stupid standards. As a person who works with insurance companies every day I am all for health care reform - everyone's lives are held hostage by greedy CEO's so what's the difference if the government takes over.

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  • elena's Avatar
    Posted by elena Thu Oct 22, 2009 1:50pm PDT

    Also, to answer another one of your questions directly: the insurance company always holds the right to cancel your policy at any time. If it's an employer-sponsored plan they can't decline her for any reason, but can put a pre-existing limitation on her "condition" if she hasn't had credible coverae within the last 63 days. For individually purchased plans they can decline, rate up, or put exclusion riders on whomever they choose and for whatever reason they decide, regardless of their underwriting guidelines.

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