In ‘Jubilation’ She’s Not: Baby Cecilia Denied Coverage In Individual Market

cecilia2.JPGAcid reflux, a benign condition which afflicts about 50 percent of infants, can exempt otherwise healthy babies from coverage in the individual insurance market place, the Pittsburgh Post Gazette reports.

Consider the story of Cecilia Kownacki, a 7-month old baby (pictured on the right), who was denied coverage by a Pittsburgh insurer because she was unable to digest milk and often spit up:

Cecilia Kownacki found out the hard way. The denial letter from Highmark arrived last month: “Dear Ms. Kownacki: [We] are sorry to inform you that your application does not meet our underwriting criteria for approval,” the letter said…Her parents, Frank and Susan Kownacki, were considerably more distraught. Their baby daughter was uninsured, starting Friday.

“When we got the rejection letter,” said Mrs. Kownacki, of the North Side, “I was in tears.”

[…] whether you’re 70 years old or 7 months young, when you move away from one plan and try to enroll in an individual plan, you can be subject to health screenings if you want to enjoy a low-premium policy.

Unfortunately, Cecilia is not the exception; nearly 90 percent of people seeking coverage in the individual market “never end up buying a plan, finding it either very difficult or impossible to find one that met their needs or is affordable.” From a recent Commonwealth study:


In “most states, individuals with preexisting conditions are denied coverage, have conditions excluded, or face much higher and often unaffordable premiums.” Insurance companies will disqualify patients from coverage for undergoing caesarean sections, or “for just taking certain medicines because of the possibility of future costs, including common drugs as Lipitor, Zocor, Nexium, and Advairpre.”

As Julia Eisman of Stand Up For Health Care notes, “when the insurance company practice of cherry-picking the healthiest among us is so picky not even baby Celia can get coverage, there’s something wrong with this picture.”