This is what a “pre-existing condition” looks like

alex-and-kelli-lange.jpg

Meet Alex Lange and his mother, Kelli. Alex is, as you can see, a nice healthy baby. His pediatrician thinks so, too. But guess who doesn’t…

Alex’s pre-existing condition — “obesity” — makes him a financial risk. Health insurance reform measures are trying to do away with such denials that come from a process called “underwriting.”

“If health care reform occurs, underwriting will go away. We do it because everybody else in the industry does it,” said Dr. Doug Speedie, medical director at Rocky Mountain Health Plans, the company that turned down Alex.

By the numbers, Alex is in the 99th percentile for height and weight for babies his age. Insurers don’t take babies above the 95th percentile, no matter how healthy they are otherwise.

In other words: He’s a nice healthy baby, who just happens to be on the big side of what’s normal for a 4-month-old. But by the insurer’s definition, that makes him “obese”.

If you think that‘s ridiculous, wait’ll you see what the insurer wants his parents to do about it before they extend coverage:

“I could understand if we could control what he’s eating. But he’s 4 months old. He’s breast-feeding. We can’t put him on the Atkins diet or on a treadmill,” joked his frustrated father, Bernie Lange, a part-time news anchor at KKCO-TV in Grand Junction. “There is just something absurd about denying an infant.”

Yes, really. They want the parents to withhold food. And this at a time when babies are supposed to be fed on demand, because in that first crucial year of life, they do a LOT of growing!

But here’s the part that really got to me:

At birth, Alex weighed a normal 8 1/4 pounds. On a diet of strictly breast milk, his weight has more than doubled. He weighs about 17 pounds and is about 25 inches long.

“I’m not going to withhold food to get him down below that number of 95,” Kelli Lange said. “I’m not going to have him screaming because he’s hungry.”

Alex weighed slightly less than I did (which was 8 lb. 9 oz.) when born. I was a skinny kid and a slender teenager, which just goes to show you that baby fat doesn’t stick around once you’re out of diapers. And no, I was not terribly physically active, either!

Alex’s weight gain is not due to junk food or a couch-potato lifestyle, it’s due solely to his mom’s own milk. She is, as you can see, not a fat lady. And he certainly doesn’t look dangerously obese to me–I expect all healthy, well-nourished babies that age to have chubby little cheeks and rounded arms and legs.

It’s ridiculous to generalize about health based on weight anyway, but in a baby it’s just beyond the beyonds. And it makes me wonder if part of the so-called “obesity epidemic” isn’t, in fact, a concerted effort on the part of insurers to deny coverage capriciously and fatten up their wallets instead.

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2 Responses to This is what a “pre-existing condition” looks like

  1. Polaris says:

    After the Alex Lange story was in the news for a while the insurance company changed its mind and decided to insure the child. But I wonder how many other people of all ages are unjustifiably denied and unable to be helped by widespread publicity.
    In the photos Alex looks big and hefty but his waistline appears to be fairly trim. I have known lots of chunky babies who became lanky adults.
    At 4 months of age I think it’s much too early for an insurance company to leap to any conclusions about such a baby.

  2. Yes, it’s ridiculous to jump to conclusions about any baby. Especially since his mother didn’t have gestational diabetes or any of the other problems that go with a genuinely overweight fetus. He wasn’t one of those 14-lb. giant babies when he was born, and he doesn’t look like a junior sumo wrestler even after his rapid weight gain. Even if he did, it’s still wrong to deny coverage or care–a baby with any kind of health problems should be getting more, not less, coverage.
    That’s one reason I’m glad for our Canadian system–doctors here practice medicine, not wallet biopsies and denial-of-care paperwork. If he did have any abnormalities, he’d be getting treatment for them, and no insurer would be raising a fuss. Only the urgency of the problem would dictate how soon he got to see a doctor, and how much medical attention he’d receive.

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