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The case of the obese baby and the insurance company

Submitted by on Monday, 12 October 2009 No Comment

Have you come down from the ceiling yet over the story about the nine states where  insurance company can refuse to provide health coverage for domestic violence victims because the abuse is a “pre-existing condition”?

Here’s another one guaranteed to send your blood pressure through the roof – though if you’re in the market for insurance, you should skip this lest you’re rejected for the pre-existing condition of hypertension:

A company in Colorado initially refused to cover a 4-month-old because they consider the baby obese – a pre-existing condition. Which is kind of funny, considering that the government doesn’t even have benchmarks for obesity in children younger than 2.

Ay, but Rocky Mountain Health Plans does. It considers anyone higher than the 95th percentile to be obese. Young Alex Lange, who is 25 inches long and weighs 17 pounds, is in the 99th percentile.

He’s exclusively breast-fed and isn’t eating solid foods yet. His mom jokes that maybe she should start him off on Slim Fast.

The company admits the system is flawed but shrugs. “Unfortunately when we try to sell people insurance, a number has to be used as a cutoff,” its medical director told a Denver television station.

As if selling is their primary goal. It’s not: It’s profit.

Yes, Rocky Mountain is a not-for-profit – but that’s not the same as a non-profit charity. A not-for-profit can rake in as much cash as it wants. It just can’t issue stock or pay dividends.

It can, however, make a profit and Rocky Mountain apparently does that pretty well. According to its most recent review by The Street, which rates insurance companies’ financial condition, Rocky Mountain weighs in at 9.5 out of 10 on profitability. Overall, Rocky Mountain has an A+ rating.

That’s no doubt a comfort to those who constantly fret that their insurance company might go belly-up. Probably far more folks worry these days, though, about whether they’ll get the care they need when they need it.

Rocky Mountain, of course, is not alone in its profits over people stance.

Hear companies such as Aetna cry the blues when profits drop 28 percent – but note that they’re still making a profit. And see the CEO say he doesn’t care if the company has fewer customers if that’s what it takes to make more money. “We have a clear bias toward profitability over growth,” Ronald Williams told Reuters in July.

And if an insurance company has to refuse to cover a 4-month-old for the sake of profitability, so be it.

Copyright 2009 Debra Legg. All rights reserved.

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