Underweight Girl Denied Insurance Coverage

Underweight Girl Denied Insurance Coverage

Parents Say 2-Year-Old Girl Perfectly Healthy

POSTED: 8:25 am MDT October 20, 2009
ERIE, Colo. -- A 2-year old Colorado girl has been denied coverage because she doesn't weigh enough, KMGH-TV in Denver reported.

Aislin Bates weighed 6 pounds, 6 ounces at birth. She now tips the scale at 22 pounds.

"She's perfectly healthy, yet she has become a statistic," said Aislin's mother, Rachel Bates. "There's no reason for her to be a statistic as a non-insured person."

When Aislin's father, Rob, worked for another company, Aislin was covered under the company’s group health insurance plan.

Now that Rob is working on his own, he's had to get new insurance. The company, United Healthcard's Golden Rule, sent the family a letter, which says, in part, "We are unable to provide coverage for Aislin because her height and weight do not meet our company standards."

"It took me by surprise," said Rob Bates. "I didn’t think that her size was that abnormal and that it was something that you'd consider to be unhealthy."

"I had no idea that this would be an issue," Rachel Bates added, "because we always had group insurance with his job. I was floored when a height-weight standard prevented coverage."

A spokeswoman for United Healthcare Golden Rule said 89 percent of the people who apply for insurance get it. Ellen Laden, the company's public relations director, told the station that most insurers have their own propriety height and weight guidelines.

"Ours are based on several medical sources, including the Centers for Disease Control, and are well within industry standards," she said.

Laden, who said she couldn't talk specifically about the Bates' case, said, "When evaluating height and weight, we typically utilize other factors as well in making a decision, such as medical records that show evidence of treatment or any underlying medical conditions."

The Bates say Aislin is undergoing treatment for an active gag reflex.

"It's very minor and she probably will only need therapy for a few more months," Rachel said.

Rachel said that both the therapist and her pediatrician wrote letters in support of the family’s quest to appeal the insurance company's decision. Both stated that Aislin is healthy and continues to grow.

"We would definitely like to see insurance reform," Rob Bates said. "We are not proponents of universal health care by any means, but what we want to see is that insurance companies have legitimate reasons for denying coverage."

State Sen. Betty Boyd, D-Lakewood, chairs the state's Health Care Task Force. She said, "If I were making the decisions, I think I would certainly cover this child."

Boyd said it behooves insurers to be reasonable when making their decisions.

"If insurers exercise reason, they're less likely to see mandates coming down the pike."

Laden said, "If a child did not meet our weight guidelines and the child was treated and continued to show steady growth for several months after treatment ended, in most cases we would reconsider covering the child."

Laden added that comprehensive coverage is currently available through Cover Colorado for individuals who don’t qualify for health insurance in the individual market. The Bates family said they’re working with COBRA, a temporary insurance, but they said it costs as much to cover Aislin under COBRA as it costs to cover the remaining three family members.

"You’d never think that something like size, something that seems so irrelevant to your health, would be a discriminating factor," Rachel said.

In a previous case KMGH covered, a 4-month-old boy was denied health insurance coverage because, at 17 pounds, he was considered overweight.

In that case, Rocky Mountain Health Plans changed its policy and now says it won't consider obesity a pre-existing condition barring coverage for hefty infants.

The Bates family hopes United HealthCare's Golden Rule has a similar change of heart.

http://www.thedenverchannel.com/health/21348145/detail.html