I don't believe any child should be denied insurance coverage. What if it was there own child, how would they feel then?

My best friend is an RN and at least as knowledgeable (if not more so!) than any physician. I've stopped going to doctors whom I thought were idiots and been seen by some RNs that were very smary and competent. I just don't think these insurance companies need all the pull that they have to decide who gets covered and who doesn't. I was denied being on my husband's policy while I was on Accutane because they said I was 'too high-risk' because of it.

Insurance has no right making medical decisions

But this is not about the right of making medical decisions, it is about the obligation to make profit decisions.

Insurance companies manage risk and money, not health care. In a free market a company must make the decisions that maximize profits.

And this is precisely WHY there needs to be reform - to MAKE the insurance companies accountable to the people they insure. Anti-reformists are up in arms about medical decisions, well take a GOOD look at what this company did. They made the decision to withhold insurance from a child without knowledge of the situation, even when their own doctor gave evidence the company was WRONG. These companies first inclination is to DENY. That's ALL they want to do and you have to fight to get them to give the coverage one should have had in the first place.

We used to call my daughter a fluff. Though about the same height as her friends, she was very light weight and small framed. She still is today at 20. She's about average height, has a very petite frame and weighs below average - and she's perfectly healthy. Health insurance companies are not medical doctors. They are simply in the business of gouging a helpless, trapped public.

It's time for serious insurance reform - along with a public option and tort reform. The American people say ENOUGH!

I hope the public option that "everyone" wants is run better than Social Security or Medicare! I am leary of the government taking my hard earned money to pay for something that they cant run well! That will not fix anything. There have to be checks and balances that result in fewer lawsuits and lower costs across the board. That includes the government run as well as the private run systems!

Amsst95- are you saying that you know no one who is using Medicare and doesn't think it's effective?

Why do people get outraged about the children who are denied coverage by insurance companies and then say they still want insurance companies to run health care? Do you not understand that insurance companies don't have a vested interest in paying out for health care? Their business model is in fact to pay out as little as possible. The government has done a perfectly fine job with Medicare and Social Security. My mother has both and they work very well for her. We should have coverage for everyone under Medicare.

ehorth, that actually is not the business model. Failure to pay claims is the number one reason why companies and employees dump their carriers. But there are systemic impediments to flexibility. It's HARD to switch carriers, and so long as your employer is responsible for providing plan options to you, it's even harder. IF carriers knew you could walk away from them if they were too stringent with coverage and IF pre-existing condition clauses were illegal in insurance contacts, you'd find that the business model would place more emphasis on customer retention.

Note that the filing of claims on auto or home insurance results in two things almost every time without fail 1) higher premiums and 2) higher experience mod ratings which means you take one giant step closer to being cancelled. We don't jump up and down about it too often because we file exponentially fewer homeowners and auto claims versus health care claims. Why should it be any different in the health care arena. If you cost the insurance company more, they will charge you more and you will become more difficult to insure. Even a public option run by the government will experience the same issue, with the only difference being that the government option will be funded directly by the taxpayers so we'll all pay twice for the ever expanding costs of the coverage. There are ways to make a public option workable and to use it to help reduce cost but it won't happen until pre-existing condition clauses are banned and the impediments to competition are removed.

Yes, there are literally thousands of insurer's out there, but they aren't all necessarily competing with one another, and they also all know that you can't take your toys and go home if you want to and not play their game. Once they know you can vote with your feet and your wallet, they'll alter the model significantly.

Homes and cars are not living, breathing entities. YOU are. Comparing health insurance to car and home insurance is like comparing apples to bananas. Not everyone has a home they own, or a car, but EVERYONE needs health insurance.

UHC is just terrible overall. My daughter was born 8 weeks premature, out-of-network, due to an emergency situation. They denied me, and my daughter's 7 week hospital stay, for over a year. I went through appeal after appeal, respectfully, until I turned all the documentation over to our state's Commissioners Office. Thank the stars that I live in Wisconsin and have a competent Commissioner of Insurance Office. They sent out a letter two weeks after I mailed all the documention to them demanding to know WHY the bills have not been paid. Five days after that CC'd letter, I received notification from UHC that they were paying everything in full. Unfortunately, they wouldn't reimburse me any of the costs I had paid in order to avoid collections, and I was too tired to even fight about the few hundred dollars I had spent.

I still believe that UHC acted illegally, as they had 30 days to make a payment in the first place and had no reason to deny, other than to make my life miserable. It was the most stressful time in my life ever, as I almost died, my daughter had major issues, and this insane insurance company didn't fulfill it's contract. In my opinion, UHC is nothing more than a bunch of crooks trying to get away with illegal activity. They, and insurance companies like them, give the entire industry a black eye.

You're right. You should be a Senator.

Any of our Senators who are allowing themselves to be controlled by these companies are not fit to hold office, and should be impeached for ignoring the will of the people.

Do you see the irony in your comment about the insurers stealing us "blind". I know it's just a phrase but it made me smile since if we did go blind, they wouldn't want to insure us!! Or at least raise our rates!

who do you think the insurance companies learned to rob the American public from? Our leaders in Washington, that's who!!! When is Obama going to turn his sights on limiting their pay and benefits???? I'd like to see their golden parachutes yanked out from under their self-serving butts and have to rely on Medicare and Social Security too. I certainly don't get my spouse's salary for the rest of my life whether he's still working at the company or not! Why should the spouse's of our Washington elite get a salary just for being married to them? And when our Senators and Congressman are voted out of office, they should stop getting a salary off the taxpayers!!! Get out and get another job!!! Just like the rest of us!

who do you think the insurance companies learned to rob the American public from? Our leaders in Washington, that's who!!! When is Obama going to turn his sights on limiting their pay and benefits???? I'd like to see their golden parachutes yanked out from under their self-serving butts and have to rely on Medicare and Social Security too. I certainly don't get my spouse's salary for the rest of my life whether he's still working at the company or not! Why should the spouse's of our Washington elite get a salary just for being married to them? And when our Senators and Congressman are voted out of office, they should stop getting a salary off the taxpayers!!! Get out and get another job!!! Just like the rest of us!

Very well put. my fear is, where doe it(denials) stop and this has the nasty flavor of "our" countries intellectuals suedo-science of Eugenics in the early 20th century.

I agree that our health care system needs to refurbished - but what about those of us that can't afford $5,000 in Health Savings Accounts? That wopuld be $20,000 for a family of four, about half of our income. The premium of $400 a month is much more affordable to us than saving even $5,000.

Law suits for inconsequential things should be made illegal; Such as suing a surgeon for the scar left from a surgery. That would lower malpractice insurance and the savings should be passed down to the patients.

Every state should have readily available insurance with no underwriting for children and low cost insurance for adults with preexisting conditions.

Very good question. I suspect that since an employer pays upwards of $15,000 per year to fund health insurance premiums, that is one logical source for the funding of an HSA. One big criticism of HSA plans today is that the large deductible insurance plans - still have a deductible, which means the insurer still controls what constitutes a covered item that falls within the deductible and those that fall outside. We should do away with deductibles alrogether and remove that power from the insurer.

By the way, the actual cash cost for a family of four's medical care for one year, if no one has a major illness, and if mom and dad each take one routine medication (Lipitor, etc) is approximately $2300 per year. If you pay $400 per month for premiums AND pay copays on top of that, you are paying more in premiums per year than the actual cost of your health care.

If we're going to have state run health insurance options, open it up so that states can compete with one-another, much like the 529 savings plans.

And, HSA savings deductions would allow you to save in the HSA, allow the funds to grow tax free, and allow you to roll over unused funds to the next year.

I wanted to have the Health Savings Account.  But the law is stupid.  In order to qualify, you must first have primary insurance.  Because of the cost of insurance and our lack of income to support it, we have no insurance.  Seems to me I should be able to have a Health Savings Account ESPECIALLY since I have no insurance.  We have raised 3 kids without insurance, but now that my spouse is over 60, we could use some insurance and a little medical care.

I agree that the current state of HSA's is ridiculous. It's tie to insurance must be severed. It should not serve as the "deductible" to a primary insurance plan nor should insurance control deductibles ever again.

The child has not been denied health care. The child has been denied insurance coverage. Care is available.

I don't disagree with the sentiment behind your post at all, but I think context is important for all of these types of discussions. It is not the role of insurance to provide health care, free of charge, in exchange for the premiums due. It is the role of the insurer to provide insurance coverage for health care rendered, pursuant to a plan paid for by the insured.

To the extent that the health care is more costly than the family can afford without insurance, we have the indentity of one of the other major problems with a health care system in this county. The care is available, for a price. In fact, this particular family availed themselves of care that they knew was not covered by the insurer prior to this coverage issue arising (because the husband changed jobs).

The issue presented by this case is whether a child's weight/muscle tone constitutes a pre-existing condition under the terms of a health insurance policy. The answer should be no, in most cases; however, so long as the weight/muscle tone is associated with a diagnosable disorder - i.e. hypotonia - for which there are CPT codes, the insurer may well been within the technical right to deny the coverage. The trouble is that they are doing to to avoid covering the cost of therapy. THAT is where we need significant reform.

Pitch-1424040, let me sum this up in simple terms for you. What our insurance companies are doing is WRONG! Always has been and always will be as long as our system remains the way it is. They have got to GO!! Bring on the public option!!

Pitch: The child does not need therapy. She is developing normally and healthy in every way. I have a 12 year old granddaughter who is smaller than her 9 year old sister. She is smaller in height and weight, which does not mean she is unhealthy. The problem with the cowriters for insurance companies is they have a certain standard they follow which they believe is the way everybody should be. But in reality, no two people are exactly alike and their body structure will probably be different from anyone else. Their standards need to be revised, especially when it comes to children. My granddaughter will always be smaller than her sister because that is the way her body is developing. My other granddaughter is classified as being overweight but she has no fat to speak of because she is very athletic and active. Muscle weighs more than fat. The cowriters need to reclassify their standards and adjust with the times.

JLunn, in the story told this AM on Today, the parents stated that the child required therapy. She had a gag issue. It's part of the story. So, yes she did.

Regardless, there are lots of children that are born with actual low tone conditions that also require thereapy, whether OT or PT. That is what I was referring to.

Blue Star, I wasn't commenting on the rightness or wrongness of insurance company practices. But no one should ignore context when having these discussions. That is why I said that getting rid of pre-existing condition clauses in insurance policies makes a lot of sense.

Pitch..........

This should not even be an issue. EVERY child should be insured no matter what.

With all due respect, please point out where I've disagreed with that concept.

What I've done in several posts is illustrate how we get to the type of problem depicted this AM on Today. I don't disagree with you, at all.

But in a health care system that requires that all conditions be identified with diagnosis codes and labeled as a "syndrome" "disorder" or otherwise, you end up with such a thing as a "pre-existing condition" that allows a carrier to deny the extension of coverage.

The answer to that problem is to do away with "pre-existing" conditions. But in order to do that, you have to change other parts of the health care providing system, which I've mentioned in other posts.

Denying insurance is the same as denying care for many children.  Uninsured kids often don't get routine well maintenance or vaccinations (which puts all our children at risk). All children, healthy or not, need to be insured so their parents can afford to give them proper care when they are sick AND when they are healthy.

Sorry..I meant anorexic..not dyslexic.

How are pharmaceutical companies relevant in this context? The insurance company denied coverage (which I fully agree that refusing to cover a child is ludicrous) to a child. Pharma companies have absolutely nothing to do with this story. And doctors ARE free to determine proper medications for their patients....however, insurance companies will at times dictate which medications are covered. But a physician is free to prescribe whatever he or she sees fit. If the insurance carrier does not agree on its use (not saying I agree with it...but that's the way things ARE currently), then it is a matter of cost / benefit analysis for the patient. And if the anticipated benefits of the medication outweigh the costs....then you try to find the means to pay out of pocket. If not, then you go without (or talk to your doctor about other potential options). But there is a key distinction between "health care" and "covered" health care.

For the first 6 months of his life, my son wasn't even on the charts! Was he healthy? Yup!! Just small! His dad is only 5'8" and I'm only 5'5". He's just small!! Thank goodness we've not been denied!

I never thought I'd say this..but...I'm so glad I don't have health "insurance"! No premiums, no co-pays, no denials.

I don't go to the doctor, I'm 48, but healthy. If I did need to go, I'd go to the ER, let them bill me, then I'd decide if I could pay the bill or not, THEN, if I couldn't pay it, I'd let them report it to a credit reporting agency. My credit is being screwed over by credit card companies anyway (another thread) so....let it rain!

Yep, "only insure healthy people and never have to pay out a dime", that's the impression that United Healthcare is giving me about their "business" practices. Insure healthy people and pay the CEO a whopping huge bonus for not allowing anyone but healthy people to apply for or get their insurance.

In a few days United Healthcare will probably waffle on their position and cover the child because of all the bad publicity they are getting, just like the other insurance company did for the 17 pound kid.