We just found out this week that Kaiser Permanente denied Elizabeth health insurance coverage under the plan we applied for:
Our record review indicates Elizabeth’s current length as 23 inches and her current weight as 8 pounds 11 ounces. Elizabeth’s current weight falls below our current criteria.We have appealed but the department at Kaiser that takes care of appeals will only let us contact them via snail mail. It can take up to 30 days before we hear back from them.
17 comments:
I shake my fist at those underwriters. GRRRRR! Watch out for the mama bear!
that is the weirdest thing i have ever heard? does it imply that her weight is too low compared to her length so they are denying her coverage as if she had a "pre-existing condition"? weird, considering she is barely a month old.
I suggest contacting your local press and media. This is exactly the sort of thing that should be publicized.
Kevin's flex spending plan denied coverage on his contacts claiming it was longer than 90 days between the prescription and the contacts order. Our records show it was something like 12 days between. They have some random dates that they must have made up themselves, that have 68 days between them. Whoever was trying to make up dates in order to deny the request can't do math very well.
Are you kidding me?!! Those insurance companies are RIDICULOUS!!!! Unbelievable.
Oh my goodness, you've got to be kidding me.... May the fury begin.
Candice:
Yes, you've got it exactly right. They took most recent well child visit measurements. While she was a normal weight for her age, she is so tall that she doesn't qualify under their conditions.
At her most recent well visit these were her stats:
height for age > 97 percentile, weight for age between 50 and 75 percentile, weight for length percentile < 3.
If they had used her birth stats from 2 weeks earlier, I think she would have qualified, though I'm not sure since nobody from that department will speak with us.
Stats from birth:
height for age > 97 percentile, weight for age = 90th-95th percentile, weight for length percentile = 3rd - 5th.
stats obtained from http://www.justmommies.com/articles/infants_growth_calculator.shtml
I think if we were able to get her reweighed today she would qualify. She has put on weight since her last visit. Since we can't reach anyone from Kaiser that can reverse the decision except through snail mail, we are forced to wait.
That sounds like discrimination against tall, thin people. Yeah, don't get me started on health insurance companies. Ever since the coverage under my full-time job ended, I've had trouble finding a company to insure me. I had to go through HIP Utah.
Thanks for posting the picture of Elizabeth. She's beautiful!
Sorta makes me appreciate our socialized healthcare up here.
SICK SICK SICK.
Don't you just love insurance companies? I hope they come to their senses soon!
You should feed her more ice cream and chocolate via her milk. If that doesn't help her chunk up, then at least maybe it will help YOU feel better.
The same thing happened to our son John with one of their babies. John remeasured the baby at home, and Baby Milo shorter than the nurse had measured. oops! Well, even nurses make mistakes.
ReCheck and do appeal, especially with your pediatrician.
We went to the doctor today (and paid out of pocket) to have her remeasured and weighed. The good news is she now weighs 10 lbs. However, she has also grown over an inch, so she is now 24 1/4 inches, which does not improve her height/weight ration.
In our favor, the doctor (3rd pediatrician we've seen) said she was perfectly healthy, except for a cold, and said he would mark that in her history.
I need to amend my comment. I think the reason we were excluded was because of weight for length. It may be something else. It may be that she had not recovered her birth weight by 2 weeks. We don't really know other than it is weight related and nobody will tell us what the actual criteria are.
that's ridiculous!!! so frustrating, and even more frustrating that you can't just CALL somebody to talk to. clearly they've got this evil-plan thing all figured out...
ditto to erica, I love public health care for the normal stuff.
Or maybe it's because nobody looked at the birthdate and they are thinking she is a very short, light adult...implying ... something...
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