Donate a Kidney, Lose Health Insurance

http://www.aarp.org/health/health-insurance/info-11-2012/kidney-donor-denied-health-insurance.html

You may have trouble getting private insurance if you're an organ donor

by: Candy Sagon | from: AARP Bulletin | November 6, 2012

How can a perfectly healthy father donate a kidney to his daughter and then be turned down for health insurance on the grounds that he has a preexisting condition?

That's what happened to Radburn Royer, 57, a retired high school teacher in Aitkin, Minn. His daughter, Erika, 31, was on dialysis three times a week because of kidney failure from lupus. "I had to help her," he says.

So, like any potential organ donor, Royer was carefully screened, found to be healthy and allowed to donate a kidney to his daughter, who is no longer on dialysis.

But now, Royer can't get private health insurance. Instead he buys coverage from the state's Comprehensive Health Association high-risk pool, which costs him $130 more a month and has a higher deductible.
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Before his daughter's transplant, four years ago, Blue Cross and Blue Shield of Minnesota provided Royer's health insurance. But it rejected his application for coverage last year and has turned down several appeals. The reason: "chronic kidney disease." Blue Cross and Blue Shield cites the higher than normal creatinine levels in his blood, Royer says. Creatinine is an indicator of how well a kidney is functioning, and donors tend to have higher levels.

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Unfortunately, Royer's dilemma probably won't be resolved until 2014. That's when provisions in the new health care law take effect to prevent insurers from denying coverage due to preexisting conditions.

http://well.blogs.nytimes.com/2012/06/11/the-reward-for-donating-a-kidney-no-insurance/

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There is little data on how often kidney donors have trouble obtaining insurance, but advocates say the fear of being uninsurable may be a powerful deterrent to donation. A 2006 study done by an advocacy organization for transplant professionals found that 39 percent of transplant centers reported that they had had eligible donors who declined to donate because they feared having future insurance problems.

The health of living donors is seldom at issue: Though some research suggests that kidney donors may be slightly more prone to develop high blood pressure as they age, long-term studies have found donors live as long as other healthy people. One study reported that donors live even longer.

Most insurers maintain that prior kidney donation does not affect coverage decisions or premiums, but while transplant cases like Mr. Royer’s are rare, advocates and social workers who work closely with donors say the problem may be more common than is recognized. A review study published in 2007 by Canadian researchers found that as many as 11 percent of them have encountered problems with life and health insurance coverage.

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Linda Bramblett, a 53-year-old self-employed swim instructor from Great Falls, Va., was denied health insurance in 2010 after telling her prospective insurer that she was planning to donate a kidney to her younger brother. She was in good health and had already been approved for surgery, and went ahead with the donation in December 2010, she said.

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Susan Galbreath, a 42-year-old from New Boston, Mich., who is on dialysis, said a friend was going to donate a kidney to her but changed her mind after a conversation with an official from her insurance company, who said her future coverage would be determined on a “claim by claim” basis.

“The conversation left her feeling very very uneasy, and I told her she shouldn’t do it if anything made her uncomfortable,” Mrs. Galbreath said.

Insurance is not the only problem donors may face. Some run into difficulties at work if they need more time to recuperate than anticipated, said Diane Zocchia, a kidney donor who works for the National Kidney Registry, a nonprofit group that assists in living-kidney donation, and who is starting a new organization, Living Kidney Donors Alliance. Women of childbearing age should ask an obstetrician about the implications for future pregnancies of having one kidney, she said.

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“The literature says that if you have kidney problems you’ll have more heart disease, but taking a kidney out in a situation where everything is fine is a very different story,” said Dr. Connie L. Davis, who is chairwoman of the living donor committee of the Organ Procurement and Transplantation Network. “It does not have the same implications.”

More sophisticated kidney function testing would have made this clear, said Dr. Hassan N. Ibrahim, chairman of nephrology at University of Minnesota and director of the kidney transplant program, who has written extensively about the long-term health outcomes of kidney donation.

New research, not yet published, suggests the risk of developing kidney failure is even smaller for living kidney donors than for the general population, he said.

Dr. Connaire said he was especially disturbed that people who commit such a generous and giving act would be penalized for it.

“Kidney donors are some of the finest people you’d ever want to meet,” he said. “I enjoy working with them very much. It keeps my faith in humanity afloat.”

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Individuals considering donating a kidney should give the matter of future insurability, for both life and health coverage, careful consideration. Tell your doctor if you engage in contact sports or other risky activities, because you will need to protect your remaining kidney from trauma after donation.

It’s important to maintain continuous coverage and never let health policies lapse. Health coverage provided through a large employer group tends to be more secure, but be aware that circumstances beyond your control — like a spouse’s death, illness, divorce or a layoff — may disrupt coverage.

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