What is Organ Transplants
An organ transplant is the transplantation of a whole or partial organ from one body to another (or from a donor site on the patient's own body), for the purpose of replacing the r...
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Insurance "Pre-existing" Hastles
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I am quite curious to know how many folks who have received transplants have or may be going through, hastles with insurance companies covering them because of their "pre-existing" condition.
You can read my profile to see all of my specifics but in a nutshell I have had my kidney transplant since '04 (doing well!) & have been physically able to hold a full-time job since I received it. I was working as a "Patient Service Specialist" (temporary)at the largest hospital in the Seattle & receiving full benefits. When I left the job & was unemployed I remained on their COBRA program. I started my current job the first of July '09 & was to begin receiving benefits immediately. HOWEVER, there is a specific clause with the Premera Blue Cross plan in the "pre-existing condition limitations" portion that has in large letters "ORGAN TRANSPLANT" then reads "Organ & bone marrow transplants are limited to a $250,000 lifetime maximum with prior Premera Blue Cross approval. Benefits are subject to a 6 month waiting period which will not be waived or credited for any reason" My assumption was that as long as I had had continuous coverage it was illegal in the state of Washington to put anyone on a pre-existing waiting period. However, upon calling a representative from the company, who then spoke with her Supervisor, I found out that this waiting period is non-negotiable. Have any of you run into this same situation? If so how did you pay for your healthcare? As many of you already know the medications alone can be well over $3,000 per month... not including Dr. visits, bloodwork etc. My friends are having to hold a fundraiser just to help me get the meds I need. My dr. this past month actually offered to waive his fee. He is also, in addition to being a physician, having to play Social Worker as well. As many of you may have found out already (I certainly have had my share of time spent) the government doesn't see transplant recipients as being "disabled"... & to a certain point, they are right... according to the strict definition of being able to work at least 20 hours a week. My point is that our meds, Dr. visits, bloodwork etc, ARE our "wheelchair" (for lack of a better word)... without proper, continual treatment we would be back on dialysis & the government would have to spend WAY more money on costly dialysis treatment(s)... I, for one, am SICK TO DEATH of being punished for having a chronic health concern. The stress of constantly paying costly co-pays, while holding a full-time job with all of life's regular stressors, I feel, can worsen our already compensated health concerns. I'll stop there... Anyone else "hear" me on this? Thanks for your time! Troy Mink Posted on 08/10/09, 05:08 pm |
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Have you tried dealing with this at the STATE level as opposed to the insurance company? Insurance companies come up with all kinds of bulls*** to say they won't pay for something. Do not nec. go by THEIR rules, the state of Washington might have something different to say. If you had Medicare with your transplant you have continous coverage--and they are probably trying to game you. Its a hard battle, I know. Been there done that, have to fight with insurance for every last benefit. Its a full time job. 
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You might do well to consult a paralegal or lawyer on this.
Insurance companies seem to dance around issues a lot when they think that they can get away with it, but the minute you get a lawyer involved that knows their way around the federal, state, and local laws, they seem to get tired and need to sit down and just work with you.
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A big AMEN to Vegaskidney's answer!
Its just sad that it all has to come down to these fights, its the last thing a patient needs. I'd like to punch out all those screaming about socialism whenever healthcare reform is brought up. Wait until they get sick! Its to the point where my friends all know when I've been dealing with the insurance issues, I go from somewhat cheerful and wise, to crying, screaming and irritable. As if I didn't have enough problems with the immuno's.
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Our healthcare programs definitely need to be fixed. I'm just not sure that the government is the right direction to go on this.
We need the Healthcare Programs fixed, not tied up more with beauracratic red tape. Sad thing is. . . we need the lawyers to help us get our issues fixed, but they're also the ones we need to get rid of when it comes to healthcare. They've really figured out a way to ensure job security for themselves. GET RID? - DON'T GET RID? -- Now that's the question.
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