Heavy infant in Grand Junction denied health insurance – The Denver Post

This is just appalling. Long story short, a health insurance company refused to cover a 4 month old baby because he was in the 99th percentile for weight. They state that they don’t cover any baby above the 95th percentile in height or weight.

Ignoring the moral and ethical qualms of not covering a perfectly healthy 4 month old, the concept of basing it on percentile is absurd.

Suppose that someone figured out a way to have all the babies in the 95th percentile and above lose enough weight to drop below the 95th percentile. You’d think they would all be able to be insured, right? Wrong. Since it’s percentile based (and not raw data based), the actual value of the 95th percentile would be recalculated based on the existing population. This means that no matter what weights the entire population is, the insurance companies are deciding that 5% of babies are completely uninsurable, regardless of their actual health. They’re deciding that 1 out of 20 babies don’t deserve any kind of insurance, not because they’re unhealthy, but because they’ve decided to use a percentile based system to define insurable and uninsurable. Percentiles change based on the overall population.

Combine this with the insurance company’s statement that they don’t take babies with height or weight over the 95th percentile is tantamount to stating that 10% of all babies don’t deserve their health insurance.

As a quick aside, I know that the baby height/weight percentile charts are rarely updated (about once every 25 years), so this argument isn’t 100% true, but the entire concept of basing it on percentile, instead of raw data is flawed, and is particularly flawed if you use the actual definition of percentile, and recalculate based on the current population.

It’s no wonder our healthcare system is completely broken. Arbitrary definitions of “conditions” which affect coverage are meaning that insurance companies are not only not insuring high risk clients, but also denying coverage for perfectly healthy, low risk clients.