Is there a doctor in the house (or insurance expert)?

[RevolutionStartsNow]

I am self-employed, and therefore have to buy my own insurance for myself and my family. The rates are typically very high for private insurance, but I'm not complaining because I know some people pay far more than we do, and also there are so many people who can't afford insurance at all, which is a travesty in this country. I definitely recognize the value of having insurance vs. not having it, especially when you have kids.

But we have been struggling for a couple of years to get my husband on our private plan. He's always struggled with his weight; he was overweight but not obsese as a teen, was quite fit, even thin, for many years when he was running a lot in his 30s, and then started to gain weight in his 40s. This made it impossible for him to qualify for any kind of reasonable insurance, i.e., on my plan.

He has now lost over 35 pounds, through running, excercising and healthier eating, and he looks quite fit. He's 6'3" and about about 275 pounds. Run a BMI calcluator and you'll see that classifies him as "obese". If you saw him you would not for a second think of him as obese, unless of course you're one of those people who think Nicole Richie or Calista Flockhart looks healthy.

He's just BIG. Like a football player. His legs and shoulders are enormous, because of all the running and jiu-jitsu wrestling he does. I'm not suggeting he's at an ideal weight; he has a ways to go, but this is not an "obese" guy. I see and have a lot of sympathy for people who are obese (and please, let's hope this thread doesn't turn into a flamefest about how obese people are treated in this country; I'm very sympathetic, as my parents have been overweight all my life), but my husband is not obese, except by these BMI standards.

He runs and works out several times per week, his heart (based on his resting pulse rate) is probably as healthy as a much younger man's; he doesn't smoke, rarely drinks, doesn't eat meat, and is generally just in good shape.

In our latest round of applying for insurance for him, we have been offered a plan similar to mine but with a 25% additional premium. I will probably pay it, because it's quite scary to me that he has no insurance -- he's had some regular checkups for those "male diseases" that we paid for out of pocket because we know those are necessary -- but what is the deal here? Why doesn't BMI take into account muscle mass? I suspect much of his weight is muscle in his legs, not fat.

Any advice or thoughts would be appreciated. I'm working with my insurance agent, who also knows Bryan and thinks it's ridiculous that he is considered obese, but they are stuck with what the Insurance Co. guidelines are.

[uppityperson]

1. Have you had his BMI tested beyond looking @ wt charts?

I know you can get tested other ways and places, put into water, various skin/fat fold tests taken. Not sure where, but wondering if it might be a good idea. Perhaps an athletic/sports doctor/facility/thingie?

[AllegroRondo]

2. I would get a body fat % check

and see if the insurance company will take that into account.

When I was in the Army, I knew all kinds of guys who were built like your husband. Big, but muscular. By the Army weight standards, they were overweight, but the Army was sensible enough to allow them to get a body fat % test, and if they were under the limit they were fine.

[A HERETIC I AM]

3. It isn't malicious on the part of the Insurance companies......

I am sure i am going to get flamed for this...("You're just an apologist for the criminal, corporatist, Insurance Industry CEO's ripping off Americans" etc.etc.etc.blah blah blah)...but they have to go by their actuarial, morbidity and mortality tables. I know i am not telling you anything you don't know, but the higher premium is to cover the higher likelihood he will pass away earlier than others in his age range.

If you are working with your Insurance Agent, i am sure he is looking at other companies. Has your Hubby already had a pre-approval physical? It is possible that another doctor/clinician will have a different opinion on his insurability.

Don't give up. That's really not much advice i know, but there you go.

[librechik]

4. Do you live anywhere near a public hospital?

At Denver Health middle class folks can sign up for clinical services on a sliding scale according to their income. You don't pay a monthly fee, but if they treat you, you only pay a fraction of the actual service cost, according to your income. And they definitely serve chronic illness types with diabetes and heart disease, so obesity is something they must treat too (it's a whole-patient treatment plan--I don't know what other towns have this sort of program, but it might be worth looking into. It was a lifesaver for me, back in the day...