Donors, recipients sometimes penalized by insurance companies after transplants


by Andrew Horansky / KHOU 11 News

Posted on June 28, 2012 at 11:44 PM

Updated Friday, Jun 29 at 4:35 PM

HOUSTON --  Five years ago, Rex Maus of Houston received a new liver. Today he says he is healthier than ever.

“My labs are great, my liver is healthy, I don’t have high blood pressure, I don’t have diabetes,” he said.

Still, Maus has his troubles.

“I was rejected for life insurance by company after company—because I received a liver,” he said.

Yet it is not just patients who are penalized. After his experience, Maus began a support group on Facebook called “The Transplant Community Outreach” and learned that donors suffer too.

“It’s just crazy” he said.

They include people like Linda Bramblett, of Virginia, who gave a kidney to her brother.

“The wait list at the time was going to be much longer than his given time to live,” Bramblett said.

The self-employed swim instructor said that as a consequence of her decision, her status changed with potential insurers. They claimed she had a preexisting condition and denied her coverage, despite her good health.

“I had to go to surgery without health insurance,” she said.

“I have run into people who say ‘if I had known this, it would have changed my decision,’” Maus said.

And though hospitals are required to notify donors of the potential risks to their insurance, not all patients say they are notified.

A few years ago, Philip Knisely, of Austin, gave his kidney to a co-worker. He said no one ever told him that it could affect his coverage if he switched plans.

“Even though I work at a job where I don’t think I’d be fired, there is no guarantee,” Knisely said. “I just wish the financial risk, the insurance risk, was better stated to people who are donors.”

In Texas, it is difficult to know how many donors are penalized, since the state’s Department of Insurance does not track them.

According to Blue Cross and Blue Shield, the state’s biggest health insurance provider, coverage is handled case-by-case. Factors such as kidney function, high-blood pressure, cardiovascular impairment, and a urinary abnormality could lead to changes in a donor’s status.

But doctors say such complications are relatively rare.

“We see no disadvantage to a healthy donor,” Dr. Eileen Brewer, medical director, renal transplant at Texas Children’s Hospital said. “They bounce back within three-to-six weeks, they go back to work, they resume a normal life, and they do everything they did before.”

Nevertheless, Dr. Brewer said that she has seen prospective donors opt out of surgery in fear of losing their insurance.

She finds it especially discouraging, since Texas has one of the country’s lowest percentages of donors.

Observers say the Supreme Court’s upholding of President Barack Obama’s health care law will one day make it illegal for insurers to deny coverage to adult donors. The law takes effect in 2014.