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Old 18.11.2015, 18:29
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Contesting medical insurance rejection

Hello,
Has anyone successfully contested a medical insurance rejection? This is for supplementary insurance.
They have rejected my very sporty, slim son, saying he is overweight for a second time. In every single child bmi calculation we have done online it says his bmi is in the healthy range (closer to underweight than to overweight). The school nurse says he is not in the slightest overweight, but the insurers insist he is.
I'm completely baffled. His height is 152cm and he weighs 39kg. He is 9 years old. What are we missing?

Last edited by Daff; 18.11.2015 at 18:32. Reason: added his age
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Old 18.11.2015, 18:37
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Re: Contesting medical insurance rejection

Your son is a giant!

Mine is 9 too. And 130 cm for 23 kg

Perhaps they're thinking you're lying on the application form?
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Old 18.11.2015, 18:37
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Re: Contesting medical insurance rejection

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Hello,
Has anyone successfully contested a medical insurance rejection? This is for supplementary insurance.
They have rejected my very sporty, slim son, saying he is overweight for a second time. In every single child bmi calculation we have done online it says his bmi is in the healthy range (closer to underweight than to overweight). The school nurse says he is not in the slightest overweight, but the insurers insist he is.
I'm completely baffled. His height is 152cm and he weighs 39kg. He is 9 years old. What are we missing?
Maybe they are just checking weight? He seems to be 99% for height and 95% for weight (i.e. normal but very big for his age) - if they just checked weight that would be very stupid but would explain the issue.

There are charts here: http://www.cdc.gov/growthcharts/data...l/cj41c021.pdf
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Old 18.11.2015, 18:42
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Re: Contesting medical insurance rejection

My guess is they are just feeding the data into a program and the program (maybe because of a bug) says "nuh-uh" -- have you tried phoning them? Having a real person on the phone to talk to?
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Old 18.11.2015, 18:44
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Re: Contesting medical insurance rejection

He is very tall. About a head taller than the next tallest boy in the class. He is also very muscular (if you can really say that about a 9 year old), he plays rugby and basketball and is on the swim team.
I don't know if they think we are lying, its possible I guess, but the school nurse did the measurements after the first rejection, so they're definitely correct.
He wears age 12 clothes, we have to take the waist in as its hopelessly too big, but the length is right.
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Old 18.11.2015, 18:48
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Re: Contesting medical insurance rejection

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My guess is they are just feeding the data into a program and the program (maybe because of a bug) says "nuh-uh" -- have you tried phoning them? Having a real person on the phone to talk to?
Yes we have, they just say repeatedly he is overweight. The first time they told us to resend the stats in case we got it wrong, but the school nurse did them, so they are correct. She did her own bmi calculation to check which also said he was healthy (right in the middle of normal weight).
Today we got the written rejection due to overweight.
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Old 18.11.2015, 18:53
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Re: Contesting medical insurance rejection

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Yes we have, they just say repeatedly he is overweight. The first time they told us to resend the stats in case we got it wrong, but the school nurse did them, so they are correct. She did her own bmi calculation to check which also said he was healthy (right in the middle of normal weight).
Today we got the written rejection due to overweight.
Weird... Maybe they're scared pay for any sports-related injuries he might get later?
A way to avoid the problem might be to ask another insurer? (And maybe not mention the rugby if it is not necessary?)
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Old 18.11.2015, 18:54
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Re: Contesting medical insurance rejection

You can contact the "medecin-conseil" of the insurance who is an independent doctor that advises the insurance.
The list of médecin-conseil per insurance and region is available here on santésuisse.ch
An alternative is to discuss the matter before with your GP.
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Old 18.11.2015, 18:59
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Re: Contesting medical insurance rejection

Could it be a case of lost in translation? Maybe they did mean height not weight.

Anyway, if it is suplementary insurance they can reject him just as its pleases them.

Edit: Just seen where you are from. Too much Netherlandish genes ;-)
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Old 18.11.2015, 19:00
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Re: Contesting medical insurance rejection

I think you may be right Squeeez as he has torn his ankle ligaments and broken his hand playing rugby and we had to fill that in on the medical history forms. But then why say he is overweight

Thank you for the link MrVertigo, I think we will have to go that route.

Last edited by Daff; 18.11.2015 at 19:00. Reason: too many lines between paragraphs
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Old 18.11.2015, 19:08
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Re: Contesting medical insurance rejection

Here a growth table which better matches your genes:

https://staff.fnwi.uva.nl/a.j.p.heck...owth/taskA.pdf
and
http://www.stefvanbuuren.nl/publicat...0Ped%20Res.pdf

Still quite tall.
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Old 18.11.2015, 19:15
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Re: Contesting medical insurance rejection

That was really interesting aSwissInTheUS, thanks for posting (I didn't read the whole thing, but looked at the tables ...).


He is very tall. Not from me, I'm really short at 156cm, my husband is 172cm, so not super tall either. Both his grandfathers were unusually tall though, so guessing it comes from them.
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Old 18.11.2015, 19:50
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Re: Contesting medical insurance rejection

There is no easy way to say this- but perhaps you should discuss this with his peadiatrician. Being on the 99th percentile for height- if the parents are not tall themselves, could make them suspicious that it could be due to a health problem. A peadiatrician could help assess this, and perhaps write to the insurance.

At the end of the day though- no insurance can be 'forced' to take anyone on if they don't want to- for supplementary- and there is no appeal that I am aware of- it is a business, and they run it as they wish.
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Old 18.11.2015, 20:13
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Re: Contesting medical insurance rejection

Thanks Odile, no doctors have expressed a concern but it's worth thinking about.

Just a knee jerk reaction to the rejection letter, I'm less emotional now. Will get him assessed with an independent doctor and take it from there.

At least he has general insurance.
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Old 18.11.2015, 20:19
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Re: Contesting medical insurance rejection

BMI is total bullshit... it doesn't allow for muscular people, muscle weighs more than fat.

I'd ask the insurance company is you can take them to a doctor of their choosing and they can decide for them if he is over weight or not. If they won't go for that, choose a different company.
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Old 18.11.2015, 20:56
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Re: Contesting medical insurance rejection

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Thanks Odile, no doctors have expressed a concern but it's worth thinking about.

Just a knee jerk reaction to the rejection letter, I'm less emotional now. Will get him assessed with an independent doctor and take it from there.

At least he has general insurance.
You could always try a different insurance company for supplementary. They don't all apply the same criteria.

I feel for your son as it's not much fun being so much taller than the rest of the class. Our son was exactly the same and was also round 150cm at that age (can't remember his weight) but was always, and still is, dead skinny. Hubby is around 182cm and I'm 168 so we're not small but not super tall either. Now he's in first year of lycée he's really happy that he's not the tallest in the school anymore and there is one boy taller than him. He's 188cm now and most if his friends are still a head shorter than him.

When we came here he was 10 and well over 150cm and he was accepted for supplementary so it's not impossible to get.
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Old 18.12.2015, 15:34
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Re: Contesting medical insurance rejection

Hello all,
I thought I'd post an update. We had our son checked by a paediatrician, he thought they were being ridiculous, wrote a report that was sent to the insurance company and two days later we got a letter saying he was accepted with no exclusions. It's a relief but it's also strange that they will so blithely turn someone away purely because he doesn't fit into their bmi age group 'norm'. So for anyone who has tall muscular kids I would really recommend not just accepting an insurance rejection and taking it further.
Thank you to everyone for the advice.
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Old 18.12.2015, 16:02
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Re: Contesting medical insurance rejection

Glad you got it sorted!

I can't believe people in the medical profession still use BMI.

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Old 18.12.2015, 16:10
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Re: Contesting medical insurance rejection

The guy on the right is clearly on the 'roids.
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Old 18.12.2015, 16:20
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Re: Contesting medical insurance rejection

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The guy on the right is clearly on the 'roids.
I am most certainly not!!
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