I have to admit, I'm kind of obsessed with the health insurance industry today. You see, I have Anthem Blue Cross/Blue Shield through my employer, and I am going for a colonoscopy tomorrow. (I wrote about my first one here
.) I hate to be like that greeting card I have in my file waiting for my oldest and dearest friend to turn 50 which depicts an old man and his grandson on the front with the caption, "Let me tell you about my colonoscopy", and on the inside it reads "Welcome to the gross personal story years." But based on some anecdotal reading I've done, colonoscopy is one of the primary procedures where health insurers start to act up.
The facility where I have it done is an ambulatory surgical center. For a wuss like me, this place makes having this procedure tolerable. They wheel you in, they knock you out, and next thing you know, you're done. No pain, no fuss, no anxiety, no trauma. If colonoscopy is the best way to head off colon cancer at the pass by catching it early, or preventing it by snipping off benign polyps before they can turn cancerous, it's in everyone's, including insurance companies', best interest to make the procedure less traumatic. Instead, insurers are increasingly refusing to cover sedation for colonoscopy. Anthem is a subsidiary of Wellpoint, which has been denying coverage for colonoscopy anesthesia since 2005
. Aetna, the other insurance-based option my employer offers, stopped covering it in 2007
When I had my last colonoscopy, I was utterly batshit panicked about the procedure, including the sedation. I've never been a hospital patient, never so much as broken an arm. The reason I wrote that long piece after my last one was because I know there are many people like me who are terrified of this procedure. I know because I live with one, and have been unable to get him to go. Colon cancer is a lousy way to die. I remember a family friend dying of it in her 50s. She had a stomach ache for weeks, they opened her up and she was riddled with it. They closed her up, it spread to her brain and she died three weeks later. And it's relatively easy to prevent through screening. But just like outpatient mastectomies and drive-through caesarean section births, the insurance industry doesn't want to pay a penny now to save a dollar later. Perhaps it's because they know they aren't going to pay the dollar later.
Not so long ago, Rep. Alan Grayson said the Republican health care reform is "Don't get sick, and if you do, die quickly." It isn't just the Republicans; it's the entire insurance industry.
I'm lucky. I'm paid well and if the damn anesthesia costs, I can pay it...assuming they don't turn down the whole claim for some arcane reason that only they know. I pay $2800/year for this coverage, and my employer pays almost another $10,000.
I'm writing about this now because I'll be watching carefully to see what my insurer does with the bill for this. Stay tuned.
But that's not even the reason for this post. The reason is another example of how the fact that insurance companies can change the rules willy-nilly affects real people. And in this case, they want to put an infant on a diet
Alex Lange is a chubby, dimpled, healthy and happy 4-month-old.
But in the cold, calculating numbered charts of insurance companies, he is fat. That's why he is being turned down for health insurance. And that's why he is a weighty symbol of a problem in the health care reform debate.
Insurance companies can turn down people with pre-existing conditions who aren't covered in a group health care plan.
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.
"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."
Bernie and Kelli Lange tried to get insurance for their growing family with Rocky Mountain Health Plans when their current insurer raised their rates 40 percent after Alex was born. They filled out the paperwork and awaited approval, figuring their family is young and healthy. But the broker who was helping them find new insurance called Thursday with news that shocked them.
" 'Your baby is too fat,' she told me," Bernie said.
Up until then, the Langes had been happy with Alex's healthy appetite and prodigious weight gain. His pediatrician had never mentioned any weight concerns about the baby they call their "happy little chunky monkey."
His 2-year-old brother, Vincent, had been a colicky baby who had trouble putting on pounds.
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."
Speedie said not many people seeking individual health insurance are turned down because of weight. But it does happen. Some babies less hefty than Alex have had to get health endorsements from their pediatricians. Adults who have a body-mass index of 30 and above are turned down because they are considered obese.
The Langes, both slender, don't know where Alex's propensity for pounds came from. Their other child is thin. No one in their families has a weight problem.
This baby doesn't eat McDonalds. They can't put him on a treadmill. But this is where the utter lack of willingness to investigate environmental or other causes of obesity comes back to bite us. There's already evidence that widely-used chemicals contribute to obesity
, but somehow I don't think there's going to be a whole lot of effort put into investigating this further. Too many industries might be hurt, and why look into real causes when you can talk the same old tired crap about fast food and laziness -- and then deny health coverage to an infant.
Labels: health care, just another outrage, weight