I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on July 15, 2009, 03:34:14 PM
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From the Los Angeles Times
Organ donors run risk of being denied health insurance
By not making clear the financial risk of organ donation, insurers put donors in danger of losing affordable coverage and discourage potential donors from helping someone in need.
David Lazarus
July 15, 2009
Eight years ago, Los Angeles resident Patricia Abdullah decided to donate a kidney to an acquaintance. She calls it one of the proudest moments of her life.
Last year, Abdullah, 61, lost her job with a publishing company. With it, she lost her employer-based health insurance.
Now she wonders what will happen if she can't find another job with group coverage. If she turns to the individual insurance market, will her act of compassion as an organ donor be perceived by insurers as a "preexisting condition," resulting in higher premiums or even denial of coverage?
"My fear is that they won't accept me because of this," Abdullah said. "It's what they say about no good deed going unpunished."
This is a blurry aspect of the healthcare system. Advocates for organ donation assert that insurers can and do treat donors as having a preexisting condition, but there is little empirical evidence to back that up.
"I'm sure it happens," said Jason Kimbrough, a spokesman for the California Department of Insurance, "but it's not something we track."
Major insurance companies, including Blue Shield of California and Anthem Blue Cross,say they take such matters on a case-by-case basis and do not have standing policies.
But medical experts and people involved with organ transplants say that by not making clear what the financial risk to an organ donor may be, insurers are putting people in danger of losing affordable coverage and discouraging potential donors from helping others.
"It's a matter of informed consent," said James Walter, chairman of the Bioethics Institute at Loyola Marymount University. "To not make this risk clear is both dishonest and immoral."
Tom Mone, chief executive of OneLegacy, a L.A. nonprofit group that facilitates organ and tissue transplants throughout Southern California, said many people probably would think twice about donating an organ if they knew there was a chance that it could affect their health coverage. "Without a doubt it would be a factor," he said. "If people thought they could potentially lose coverage for something like this, I'm sure it would be a consideration."
According to the United Network for Organ Sharing, which collects data on every transplant in the United States, nearly 6,000 people donated a kidney last year. Almost 250 people donated a portion of their liver.
I contacted most major health insurers to ask whether a person who had donated a kidney or partial liver would be regarded as having a preexisting condition and thus subject to higher rates or denial of coverage.
Not one responded with a definitive answer.
"We would have to look at the specific facts before making a decision," said Ashley Wilkerson, a spokeswoman for Blue Shield of California.
A spokeswoman for Anthem Blue Cross advised me to put the question to the California Assn. of Health Plans, an industry group.
A spokeswoman for the association told me instead to put the question to Anthem and other individual insurers.
The only major insurer that agreed to discuss the matter in some detail was Kaiser Permanente, although its basic position was no different from its more reticent kin.
"Something like this is viewed like any other complicated surgery," said Jim Anderson, a spokesman for the healthcare provider. "It would be on a case-by-case basis."
He added: "Looking for black-and-white answers to complicated medical questions is a difficult thing to do."
Not that difficult, actually. A considerable body of data exists for the well-being of kidney and liver donors after the transplants are completed. In most cases, the donor goes on to live a normal and healthy life.
"I'm perfectly fine," said Kevin Monroe, a Lakewood resident who donated a kidney to his brother in 1998. "I do everything now that I did before."
He said he's been fortunate to remain covered by his employer, the oil company ConocoPhillips. But Monroe, 56, said he's concerned about what would happen if he had to seek insurance elsewhere and had to report that he donated a kidney to a loved one. "Even though I'm perfectly healthy, it could be a problem," he said.
Health insurers are sensitive to being perceived as an obstacle to organ donation. They don't want to be seen as discouraging such selfless and courageous acts.
"We and every other healthcare organization would encourage people to donate organs," said Kaiser's Anderson.
If that's the case, the answer seems obvious: Make it the clear policy of an insurance provider to not penalize organ donors in any way.
In other words, insurers should specify up front for policyholders that donating an organ will in no way affect their rates or access to coverage.
Better yet, they should reward organ donors by offering, say, a 15% discount on premiums for at least five years as an incentive for helping others.
They should also provide free wellness tests annually to ensure that the donor experiences no complications related to the transplant.
Legislation is working its way through Congress that would eliminate exclusions
for preexisting conditions for both group and individual policies. This would be a good thing.
At the very least, lawmakers should require that insurers notify policyholders that donating an organ could result in higher rates or reduced coverage.
"The fact that someone is willing to donate an organ -- society shouldn't penalize that person," said Dr. Tse-Ling Fong, who works with USC's Liver Transplant Program and Center for Liver Disease, which conducts about 40 transplants a year.
"I feel a moral responsibility to inform patients about what they could face from insurers," he said. "But at this point, it's a huge unknown."
Abdullah, the uninsured kidney donor, said she has no regrets about having helped someone in need.
"I made a decision to save a life," she said. "How often do you get to say that?"
Even if that decision results in her being penalized by insurers, she said she would do it again -- in a heartbeat.
"But it would be better if I wasn't punished for doing the right thing," Abdullah said.
David Lazarus' column runs Wednesdays and Sundays. Send your tips or feedback to david.lazarus@latimes.com.
http://www.latimes.com/business/la-fi-lazarus15-2009jul15,0,1465891.column
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Follow-up LATimes blog discussion of preceding article:
Live organ donation seems to begin safely enough
12:13 PM, July 15, 2009
If no good deed goes unpunished, living organ donors may have need to worry. L.A. Times columnist David Lazarus weighs in today with a look at one possible effect of organ donation on such donors.
In Organ donors run risk of being denied health insurance, he writes of kidney donor Patricia Abdullah who recently lost her job and thus her health insurance: "Now she wonders what will happen if she can't find another job with group coverage. If she turns to the individual insurance market, will her act of compassion as an organ donor be perceived by insurers as a 'preexisting condition,' resulting in higher premiums or even denial of coverage?"
Advocates for organ donation say such things happen. Insurers say, well, it depends on the person.
Regardless, the need for such donations can't be denied.
What does seem clear is the relative safety of kidney donation for most people. Here's an L.A. Times report from earlier this year: Kidney donors have a normal life span, study finds http://articles.latimes.com/2009/jan/29/science/sci-kidney29
And notes this synopsis published this month in the journal Advances in Chronic Kidney Disease: "Living kidney donation continues as the cornerstone of transplantation. ... Currently, it can be stated that living donation is, on the whole, safe, with few perioperative deaths, complications, or long-term medical issues." [http://www.ackdjournal.org/article/S1548-5595(09)00088-3/abstract]
Kidney That report goes on to reflect on what demographic changes could mean for such safety, on the varying levels of risk -- and on the need for continued surveillance: "Additionally, the living donor reflects the demographics of the general population including increased rates of obesity with some donors having hypertension and low-grade proteinuria. In the long run, death rates (for the white donor) are no different than for the general population, whereas end-stage renal disease rates are slightly increased over the general population, ranging from 0.1% to 1.1%. The higher risk is especially notable in the black donor. Preeclampsia in female donors may also be marginally greater than in those with 2 kidneys. Thus, the new health age brings a rejuvenated responsibility of the medical community and those in governance to design systems that allow more complete and continued follow-up of the living kidney donor, especially those of color."
But more followup and more assessment begins with more donations.
Here's an overview of living organ donation from the United Network for Organ Sharing. (Most living organ donations are for kidneys, though it's possible to donate a portion of the liver or lung.) http://www.transplantliving.org/livingdonation/
To actually see what's involved, check out this video of a kidney transplant surgery, filmed at Sentara Norfolk General Hospital in Norfolk, Va., earlier this year. http://www.or-live.com/distributors/NLM-Flash/seh_2584/rnh.cfm?id=852 And here's Baltimore Sun coverage of a recent domino kidney transplant involving seven pairs of people, plus the man who started it. http://www.baltimoresun.com/health/bal-md.transplant08jul08,0,3811531.story
As for health insurers who don't want to be seen as an obstacle to organ donation, Lazarus has some suggestions. Among them: "They should reward organ donors by offering, say, a 15% discount on premiums for at least five years as an incentive for helping others."
Of course, that would mean that we can get away with at least some good deeds.
-- Tami Dennis
Caution: (If you are squeamish about viewing photos of surgery, don't look)
If you've never seen one, here is a close-up view of a kidney transplant surgery.
Photo: A kidney is implanted during a live donor transplant in England.
Credit: Christopher Furlong / Getty Images
http://latimesblogs.latimes.com/booster_shots/2009/07/organ-donation-kidney-risks-.html
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This is all so backwords to me.
Seems a donor should get medical benefits for life for being a decent human being. I mean in the long run do they not save insurance companies tons of money.
Ps. that is a big hole for taking out the kidney. :o
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That what I said when they took out my gall bladder several years ago.... nine inch scar.........
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I didn't watch the video, but I believe that's the kidney going in the recipient (unless that's the right kidney being removed ???). My donor was able to giver her left kidney and she has three very small scars because hers was laparoscopically removed. They inflated her stomach with air/gas and had to move around her internal organs, placing her intestines on her stomach (that's what they said), but her removal scar is just below her bellybutton and is maybe 3-4 inches long and where they cut the kidney out there are two small maybe 1-2 inch scars.
Now, my scar is about 6 or so inches big. But it looks really good. Currently it's hidden under my belly roll. yuk!