Insurance Deficiencies Leave Merrimac Transplant Recipient Fighting for Her Life

Merrimac, Wisconsin resident, Lois McDaniel, fights for more than her rights as a paid subscriber of insurance coverage -she fights for her life.

(PRWEB) February 10, 2004 --After a long battle with polycystic kidney disease (PKD), a hereditary disease, which affects many organs in the body including the kidney and liver, Lois McDaniels kidneys and liver, were finally failing. On March 14, 1998 she was awoken from an ill-induced slumber, by a ringing telephone. So shocked by the news on the other end of the line that she couldnt speak, she handed the phone to her husband. Mr. McDaniel, we need Lois to come to the transplant clinic immediately. Weve found a suitable kidney and liver and need to prep her for transplant." Came the voice from the University of Wisconsin Transplant office. McDaniel and her husband, Mick, quickly gathered her things, phoned their daughter with the good news, and rushed to the clinic.

Former Governor Tommy Thompson and many others have played heroic roles in making Wisconsin one of the most progressive states for patients in need of organ transplants. The States transplant programs and organ procurement programs are among the best in the Nation. And the University of Wisconsin Transplant Clinic and its doctors have been hailed as being among the most skilled in the world.

Now, almost six years since McDaniels lifesaving kidney and liver transplant, she and her husband spend their days worrying if she will survive. Not because her organs are failing, they are as healthy as they come. Not because the disease has returned, it has not. Not because shes old, she is a mere 56 years young and enjoying life. They worry about her survival because they cant afford the necessary anti-rejection drugs and their insurance company refuses to cover them.

McDaniels circumstances are unique. After her transplant, she eagerly returned to work just a few weeks later -- rare for a transplant recipient. Never one to accept charity, and fully able to work, it was only natural that she continue to do so. She did not apply for disability, Medicaid, Medicare, or any of the other public assistance programs -- she didnt feel she needed them. After putting in another four years with the company shed been with for nearly 25 years, she was let go during a corporate re-shuffle.

The first hiccup in McDaniels insurance coverage, though expensive, she opted for the companys COBRA benefits for the allowed 18 months. While her husband carried insurance through the International Brotherhood of Electrical Workers (IBEW) Local 2304, the coverage was poor and refused to cover her transplant medications.

During the last several months of McDaniels COBRA coverage, she searched frantically for assistance with her medications, medications which are necessary to her survival. Without them, her body would reject her organs and she would die. The alternative is constant hospitalization and receipt of the drugs intravenously. For McDaniel to die would be a waste of not one life, but two. The parents, who bravely and generously chose to donate their 18-year old daughters organs, when her life was lost to a car accident, intended for her organs to help others -- the basis of the organ donation program.

McDaniels transplant medications, without insurance coverage surpasses $3,000 per month. More than many people spend on their entire household budget including their mortgage.

Unwilling to simply give up, McDaniel contacted the Wisconsin Health Insurance Risk Sharing Plan (HIRSP) office, BadgerCare, the transplant clinic, and her husbands insurance company. Leaving no stone unturned, she sought coverage for her expensive, but necessary medications. She found that she could not receive coverage for the drugs.

HIRSP will not accept her because she is eligible for insurance through her husbands electrical union. Other insurance companies will not accept her because she is a transplant recipient -- high risk. BadgerCare will not accept her because her husband makes too much money as an electrician. And shes been told that she is ineligible for disability benefits, though she is now unable to work full time as the medications have caused severe weight gain, which has led to extreme fatigue and leaves her feeling ill a good share of the time. Plus, the medications combined with getting a bit older have dulled her once sharp-as-a-tack mind.

Out of options, McDaniel spoke with her transplant coordinator, Jean Bressler, at the UW. Bressler put McDaniel in touch with an advisor who works with transplant recipients to obtain the medications when all other options are exhausted. Many pharmaceutical companies offer their drugs free to patients who otherwise couldnt afford to purchase them. Thinking that she fit into this category, McDaniel, with the help of the UW advisor contacted the pharmaceutical companies. Again McDaniel was refused the medications because of her husbands income and insurance coverage.

McDaniel then decided she needed to try and fight her husbands insurance provider over their coverage. Her doctors and nurses suggested letters to the States Insurance Commission. While the insurance company will cover a transplant, they will not cover the medications. When asked why it is that they will cover a several hundred-thousand-dollar kidney and liver transplant, but not the medications that follow, the companys response was we count on people turning down their transplant because they cant afford the meds later."

McDaniel decided that it was indeed time to contact the insurance commission with the injustice being done by the insurance company. Again she was met with a brick wall. It seems that the insurance coverage provided to its members and their families by the IBEW is self-funded. Thereby relieving them of the regulatory policies set forth by either the State or Federal governments.

The IBEWs own newsletter to its members suggests to its following that they seek veterans benefits to take up the slack of their admittedly inadequate insurance coverage. McDaniel made a plea to the Union for coverage of her life-sustaining medications under major medical, having heard from other Union members that the company was allowing coverage for diabetics under major medical. They refused.

Under the current, and only health plan that McDaniel has access to, her medication coverage will expire within the next two months. This will leave her without the medication necessary to her survival and without the means to pay out-of-pocket for them.

McDaniel has still not resigned herself to asking for charity, just equality and the ability to continue living a good life. If the insurance company for the IBEW would simply cover the medications or move them to major medical, as theyve done with diabetics, she could have that equality and go on living. The alternative is a life spent in the hospital receiving her medications intravenously and even more costly for the insurance provider, certain death, or poverty.