Girl's case turns up heat on UnitedHealth Group

UnitedHealth Group, the nation's biggest health insurer, found itself in a touchy sideshow to the great health care debate Wednesday after a Colorado family came forward with a poignant story about how their 2-year-old daughter had been denied coverage.

Such decisions are not uncommon among insurers, but the case of Aislin Bates came with a twist -- she's healthy.

Aislin, who weighs 22 pounds, was turned down by UnitedHealth's Golden Rule subsidiary for not meeting height and weight standards. Children who are considered to be too slight are often viewed as at higher risk for contracting an illness.

While Minnetonka-based United Health and other insurers routinely deny coverage to people for various reasons, those turned away don't usually end up pleading their cases on national TV.

By Wednesday morning, the Bates family was appearing on NBC's "Today" show, after having first had their story told on the ABC news affiliate in Denver. The story was also picked up by the Huffington Post.

By Wednesday evening, UnitedHealth had reversed track. After an "additional review'' of her medical records, the company said it will now offer Aislin coverage if her family wants it.

For UnitedHealth and its peers, the story could not have broken at a more pivotal time.

President Obama last week accused the industry of trying to torpedo a health care overhaul with the release of an industry-funded study that predicted a sharp rise in premiums if the Senate Finance Committee's health bill goes forward.

The industry got more bad news Wednesday when the House Judiciary Committee voted to repeal its federal antitrust exemption to spur competition and control the cost of premiums.

About 60 percent of Americans get their health coverage through their employers. Those who don't, including the self-employed, have to apply for individual health insurance, where insurers scrutinize their age and medical history and then set a premium.

Insurers can deny coverage based on pre-existing conditions. This is true of both for-profit and nonprofit insurers, including in Minnesota. (Golden Rule does not operate in this state.)

The industry has said it will stop denying those with pre-existing conditions if the government makes everyone buy health insurance. That would stop people from not buying insurance until they get sick and get more young healthy people paying into the system.

Picky eater

While both sides of the debate are employing armies of lobbyists, their powers of persuasion might not always be as great as those of Aislin -- blond, blue-eyed and wearing a flowered dress -- who sat squeezed between her parents on the set of the "Today" show.

Her mother, Rachel Bates, said Aislin was born 6 pounds, 6 ounces. Her dad, Robert Bates, said doctors told them Aislin's small size is due to genes, not illness.

"She's just petite," he said.

The family had previously been covered by Robert Bates' employer's plan, at one point administered by UnitedHealth. But then he left and was self-employed. When they applied again as a family, according to the "Today" show, they got a letter from Golden Rule saying: "We are unable to provide coverage for Aislin because her height and weight do not meet our company standards."

The insurance company noted the Bates family had sought food therapy for Aislin because she is a picky eater.

UnitedHealth uses weight and height guidelines from the Centers for Disease Control and Prevention, said spokesman Tyler Mason. He said he was unable to share the reasons for the denial because the Bates family had not given him permission.

The Bateses are currently insured through COBRA, which allows the extension of group coverage from a previous employer for a limited time.

On TV Wednesday, Robert Bates said he had appealed the decision: "We're hoping they will change their minds."

Later in the day, he got his wish.

"As the appeals process is supposed to work, we undertook additional review of Aislin Bates's medical records and determined that in fact we can offer her insurance coverage," the company said in a statement.

Chen May Yee 612-673-7434