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Author Topic: Denial of supplemental insurance coverage  (Read 3589 times)

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Offline zempal

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Denial of supplemental insurance coverage
« on: November 11, 2020, 03:30:13 PM »
     I donated a kidney in 2016 and have lab work and checkups every 3 months. After 4 yrs in last September I learned I had a diagnosis of chronic kidney disease.
Admittedly the renal panel lab work is "abnormal", but it has been steady and is essentially "normal" for a person who is healthy and with one kidney. I understand there is a
philosophical debate" among kidney specialists in regards to differentiating ckd for normal kidney donors and those who are acutely ill from the disease. Apparently they go
just go by the "numbers" and lump kidney donors with the rest.
     I submitted an application to an insurance company for  supplemental insurance coverage( its premium is much lower than my what my present company offers).
The application was denied specifically due to the diagnosis of chronic kidney disease.
     Can insurance companies routinely deny insurance coverage to kidney donors? Is it not considered a pre existing condition? Is supplemental insurance treated differently
than other health insurance?
     Thank you for any information or assistance.
     

Offline Fr Pat

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Re: Denial of supplemental insurance coverage
« Reply #1 on: November 11, 2020, 07:27:38 PM »
I don´t know the answer to your question, but you might like to post it also at the FaceBook page of ¨Living Donors on Line¨and at the page of ¨Living Kidney Donors Support Group¨. These days there are more donors who check in there rather than here.

Offline zempal

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Re: Denial of supplemental insurance coverage
« Reply #2 on: November 12, 2020, 04:17:51 PM »
Fr. Pat

     You will not recall this, but in August, 2016 I was in the process of giving a kidney and researched Living donors online. I had a number of questions about kidney
donation and you were kind enough to respond
with some very good and comforting comments. In addition, you sent me documents on Pope John Paul on Organ donation and organ donation and the poor.
Your comments indeed helped me with the decision; at the time I certainly appreciated it.
     At present I am researching denial of insurance coverage to kidney donors. It was indeed indicated in the operative permit, but nobody at all mentioned it nor
indicated it really could be a significant problem in the future.
     It is a shame that the US does not really have a long term follow up on kidney donors. Complications due arise, and there is seemingly no resource to refer to
for help.
     Thank you.
Jim

Offline Fr Pat

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Re: Denial of supplemental insurance coverage
« Reply #3 on: November 13, 2020, 06:46:24 AM »
Dear Jim,
     HI. Thanks so much for mentioning that. Indeed over the years I have sent info and advice to so many nice people that I can hardly remember now who-is-who. I do hope that your insurance problems get taken care of. I'm still doing fine now at age 74 (75 next month) almost 19 years after kidney donation. I even still manage to do 5k and 10k runs, and once a year a slow half marathon. Always great to be in touch with others I have "met" over the years.

Offline Michael

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Re: Denial of supplemental insurance coverage
« Reply #4 on: November 13, 2020, 12:32:36 PM »
I replied to your email on this topic, but for the sake of those who visit the message board, I want to post my response to you here as well so others can see.

First, generally health insurance in the U.S. is subject to the protections of the Patient Protection and Affordable Care Act (aka "Obamacare"). One provision of that law is that health insurance cannot deny coverage due to pre-existing conditions. However, there are exceptions. The supplemental Medicare coverage you applied for is one example. "Guaranteed acceptance," where you are provided coverage regardless of your age and health, occurs at your initial Medicare enrollment (generally at age 65). After that, if you add or change coverage, you're subject to underwriting (i.e., the insurance company can deny you coverage or charge you higher rates based on your health).

There are two other types of health insurance that can have pre-existing condition exclusions. One is supplemental medical insurance, sometimes called "indemnity" coverage or voluntary insurance coverage. This is coverage provided by companies like AFLAC that pay a set amount of money to the insured (not the provider) in the event of an illness or injury. The other type is "short term" or "temporary" insurance, which is intended to provide limited (and inexpensive) coverage as a bridge between more complete coverage.

Note that there is no protection from pre-existing condition exclusions for life and disability insurance.

Second is the issue of what constitutes "normal" biometrics (creatinine, BUN, GFR, etc.) for someone who is a living kidney donor. Everyone knows our kidney capacity is diminished by virtue of donating a kidney to someone else. The result can be numbers that make it appear we have kidney disease. But what if that remaining kidney is perfectly fine and we are otherwise in excellent health? Are we really at risk? Are we really uninsurable?

Unfortunately, there isn't an answer right now. There have been "discussions" in the medical community but no action, and I'm not aware of any comprehensive, definitive study that shows LKDs can be considered healthy even if their kidney biometrics are "abnormal."

Your experience of having health insurance denied is a prime example of the consequences of not having an answer to the question. That kind of consequence is also something that is rarely mentioned in detail in educational information used for "informed consent" of potential donors. It seems reasonable to insist on getting an answer in order for future donors to be considered truly informed of the longer term consequences of donation.

So what to do? As we discussed, I'll work on seeing what research is out there that might provide an answer, even if just a partial answer. I'll dig into the message threads we've had on this message board in the past on this topic to see what we can learn. I'll reach out to other LKDs to see what their experiences have been, specifically whether they have been denied coverage because of "abnormal" kidney biometrics while otherwise being healthy. And I'll contact other LKD advocates to get their perspectives and suggestions.

Stay tuned!
Michael
Living Donors Online
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Offline Michael

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Re: Denial of supplemental insurance coverage
« Reply #5 on: November 17, 2020, 02:33:30 PM »
Here is one of Dr. William Freeman's posts (from 2011) on GFR for living kidney donors: https://livingdonorsonline.org/ldosmf/index.php?topic=141.0

The most relevant part is the second and third paragraph after the heading "Significance for us LKDs":

More importantly, please realize what the classification of GFR of 30-60 by itself really means to us LKDs.  By itself, it means to LKDs:  no-one knows!   :)

That group, "Chronic Kidney Disease Stage 3," is defined by the value of GFR alone; the definition does not require having chronic kidney disease or another disease known to be life-shortening and also adversely affecting GFR -- namely diabetes, high blood pressure, or heart disease -- in people with 2 kidneys.  (CKD 4 and CKD 5 require having chronic kidney disease.)  Most people with 2 kidneys and GFR 30-60 have one or more of those diseases, and thus are at high risk to die prematurely from them.  That definition, however, was not developed in LKDs otherwise healthy, that is, LKDs without chronic kidney disease (shown by abnormal results of urine or blood or other tests) or diabetes or high blood pressure (especially not well controlled) or heart disease -- but simply "GFR 30-60."  That definition also did not account for person's age; because most people's GFR decreases slowly as they get older, even if they remain healthy.
Michael
Living Donors Online
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