By Kathryn Doyle
NEW YORK (Reuters Health) - Although people who have donated a kidney have passed a rigorous battery of tests and tend to be healthier than the average person, many report difficulty getting or changing health or life insurance policies after the surgery, according to a new study.
“These are the healthiest people in the nation, they’ve undergone more health screening scrutiny than anybody else for any process,” said senior author Dr. Dorry L. Segev. “We only allow the healthiest people to do this.”
Segev is an abdominal transplant surgeon at Johns Hopkins University School of Medicine in Baltimore, Maryland, where the study took place.
“The thought that somebody who has perfectly normal kidney function will have to fight with their insurance company is troubling,” he told Reuters Health.
He and his coauthors surveyed over 1,000 people who had donated a kidney at their hospital between 1970 and 2011.
Of the almost 400 donors who reported getting or changing health insurance after donation, seven percent had difficulties. Some of them were denied coverage and others were told donating a kidney was a preexisting condition.
Almost 200 people had changed or initiated life insurance, and 25 percent reported similar trouble, according to results published in the American Journal of Transplantation.
“Insurance companies who are supposed to be making predictions about people’s insurability are totally misinterpreting this particular medical scenario,” Segev said.
One of the tenets of the Affordable Care Act (ACA) is that insurers can’t take preexisting conditions, like diseases and disabilities or things they interpret as a disease or disability, including kidney donation, into account when offering or pricing health insurance plans.
“The health insurance thing hopefully will be attenuated by the ACA but life insurance will not,” Segev said.
The study leaves unexplored many factors that might be important in determining whether people get accepted or charged higher premiums, said Steven Weisbart, chief economist at the Insurance Information Institute in New York.
Importantly, the researchers did not compare this group of kidney donors with a similar group of non-donors to see if they encountered more problems than the comparison group, he told Reuters Health.
“There’s nothing here about how long after donation the effort to change or buy life insurance took place,” Weisbart said. “If it was a long time they are much older, and there could be many factors to their health.”
“The life insurance market is enormous and quite varied,” he said. Some companies may be concerned about the impact of going down to one kidney and might choose to reject an applicant, but another company might accept the same person without an increased premium, he said. Kidney donors should shop around for life insurance.
There is quite a bit of evidence that even living with only one kidney, donors are healthier and less likely to have kidney problems than the general public, according to Dr. Hassan N. Ibrahim, medical director of the Kidney Transplant Program at the University of Minnesota Medical School in Minneapolis.
“Kidney donors live as long if not longer than others,” Ibrahim, who was not part of the new study, told Reuters Health.
Data to that effect have been published in Sweden, Japan and the U.S., he said.
“This is an American issue, not a European, not a Canadian issue,” Ibrahim said.
In Canada it takes donors longer to get a quote on their insurance but premiums are never raised and insurance is never denied, he said.
This particular study found higher rates of insurance difficulties than most others have found, he said. That may be because 20 percent of the donors in this group had high blood pressure or diabetes, which may have influenced their insurability.
Ibrahim suspects that between one and two percent of donors actually have problems getting or changing insurance, but even one percent of 5,000 donors per year is concerning, he said.
“It’s certainly an important social issue,” Ibrahim said. “Almost a third of people who would not consider donation are afraid of costs and insurance coverage.”
A group in the Philippines offers free insurance coverage for life for a kidney donor and the donor’s family, he noted, which incentivizes donation.
“We need to remove disincentives to donation in the U.S.,” Ibrahim said.
Kidney recipients’ insurance covers the entirety of the transplant cost. Having health or life insurance in place before the transplant may help donors avoid some struggle, but they could still need to change insurance at some point, Segev noted.
“For people who have donated kidneys the message is, remember that you are healthy,” he said. “Call your transplant center and get us in touch with your insurance company so we can educate them.”
“None of this should be construed as a reason to not donate,” he said.
SOURCE: http://bit.ly/1t35hEe American Journal of Transplantation, online July 16, 2014.