You may have read the news that a family in Colorado was told their 4-month-old son would be denied health insurance by Rocky Mountain Health Plans because of a pre-existing condition: he was too chubby.

The child in question, baby Alex Lange, weighs just 17 lbs and is 25 inches long. That puts him in the 99th percentile according to the CDC but his pediatrician says the baby is perfectly healthy.

Although the insurance company’s spokesperson, Dr. Douglas Speedie, agreed that a baby can be healthy at little Alex’s weight, he said that the line has to be drawn somewhere. “It’s a calculation based on height, weight, and a fudge factor.”  But he also said “We’d like to see health care reform so that these things go away.”

Just think of that for a minute. Why does a health insurer claim there is a pre-existing condition where none exists? And if an insurer acknowledges that this is a flawed decision-making process, why doesn’t it act on its own to make “these things go away”? Does this make sense to you?

Me neither.

And that illustrates why we need health care reform. Right now, insurers can claim people have “pre-existing conditions” that they don’t actually have, and make other arbitrary decisions to deny people care. That must change and insurance companies will not change on their own … well, except in cases where their decisions are so ridiculous that they make the nightly news.

In baby Alex Lange’s case, the negative publicity convinced the insurer to reverse its decision. But the reason that Alex’s story got so much attention is that his daddy works for the NBC TV affiliate in Colorado that broke the story.

Most other people just get stuck with the insurance company’s arbitrary decisions.

– Yvonne S. Thornton, MD, MPH