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There's nothing more scary -- and more expensive -- than needing an organ transplant. Not to worry, though, because Washington state insurers are on it! They're telling people dying of organ failure they must wait 90 days before they can even begin to be evaluated for a transplant.

Newly insured consumers in Washington state who purchased health plans through the online exchange might find a surprise when they comb through the fine print in their policies: They’ll have to wait 90 days from when their insurance begins before coverage for transplants will kick in.

The waiting period, a holdover from the days when insurers were able to impose restrictions on coverage for all sorts of preexisting conditions, has become the latest flash point in the often tense negotiations between insurers, regulators, doctors and consumers over the design of the new individual and small-group health plans that went into effect Jan 1.

Which insurers are engaging in this death panel-esque behavior? Well, let's call them out!
The waiting-period rule, which is in effect for policies sold by Premera Blue Cross, BridgeSpan Health, Moda Health and Group Health, applies to the entire transplant process, meaning that patients must wait 90 days before even beginning an evaluation. The evaluations, which include everything from screening tests to interviews with social workers and nutritionists, often take several months. Once a patient is approved, the wait on a transplant list could be several more months or even years, depending on the person’s condition, the organ involved, and the hospital.
Not surprisingly, the doctors who actually deal with organ transplants -- as compared to the insurers worried about how paying for them will hurt their stock prices -- are pretty pissed about the whole deal.
“The whole idea of creating a waiting period for someone who is dying of organ failure is the antithesis of what the Affordable Care Act is supposed to be about,” said Roslyn B. Mannon, immediate past president of the American Society of Transplantation and a transplant nephrologist at the University of Alabama at Birmingham.

Susanna Nazarian, assistant professor of transplant surgery at the University of Washington, put it more bluntly: “Putting this additional barrier in front of them will lead to some patients passing away.”

So, yes, people will probably die. Families will cry. Lawsuits will be filed. But, well, who cares? The insurance paper-pushers think this will protect their bottom line. And they're simply doing this for the worst possible reason: because they can.
Insurance company representatives said they were complying with what is allowed under the Washington state benchmark plan. Stephanie Marquis, a spokeswoman for the Washington state insurance commissioner’s office, said the original waiting period for transplants for plans purchased through the state exchange was six months but it was reduced to 90 days “to match what was allowed under federal law.”
Does the insurance industry have any shame? Well, we all know the answer.

Insurance industry bean counters are simply calculating that the waiting period will force some patients in need of transplants to die before they receive them. For what other reason would they enforce this waiting period? Especially given that a person in need of a transplant will simply demand services for said condition on day 91, while under the same insurance policy they had on the first day of coverage. This is pure sadism.

Originally posted to james321 on Sun Jan 26, 2014 at 06:25 PM PST.

Also republished by Koscadia and Seattle & Puget Sound Kos.

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