Jacksonville woman dies after insurer repeatedly denies her a liver transplant

[FR7 Baptist]

Relatives say a Jacksonville mother would be alive today if her insurance provider hadn’t repeatedly denied her request for a liver transplant.

Alisa Wilson, 37, died Friday at 8:50 p.m. after a lengthy battle with an undisclosed liver disease, said her father, Eric Wilson.

“Her liver was gone,” Wilson said. “There was no more left. She needed that transplant two weeks ago.”

In her final days, the Wilsons desperately reached out to the media and health-law attorneys to get her approved for a transplant.

Over the summer, she was turned down several times by her insurer, a Medicaid reform HMO run by Sunshine State Health.

The family switched her to traditional “fee-for-service” Medicaid because the local transplant center at Mayo Clinic Florida doesn’t typically accept Medicaid HMOs.

Like many Medicaid recipients in Duval County, Wilson was required to join a private plan as part of a Gov. Jeb Bush-era experimental overhaul of the program.

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Yet another example of health insurance companies putting profits above people.

 

[matt wade]

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Yet another example of health insurance companies putting profits above people.

This woman and her family have refused to disclose the reason for her liver disease. They want the publicity, but refuse to be forthcoming with all the details.

Why hide the reason for the liver disease? It leads one to assume that the liver disease is a direct result of unhealthy behavior on the part of the woman.

If a person takes a knife and stabs themselves in the liver, should the insurance company pay to replace it? We can extend that to participating in other risky behavior (drugs, alcohol, or risky sexual relations) that can damage the liver.

 

[annsni]

A woman I know needed a liver transplant but she would not give up drinking. We went to see her in the hospital when she was on her death bed. She took a swig of whiskey her daughter had snuck into the hospital. But the rule was, you needed to be sober for 6 months to get the transplant and she just would not give in. They had the money - but she was not sober so....

 

[FR7 Baptist]

A woman I know needed a liver transplant but she would not give up drinking. We went to see her in the hospital when she was on her death bed. She took a swig of whiskey her daughter had snuck into the hospital. But the rule was, you needed to be sober for 6 months to get the transplant and she just would not give in. They had the money - but she was not sober so....

This seems to be an issue with the insurer, not the hospital.

 

[targus]

This seems to be an issue with the insurer, not the hospital.

Paul, if this woman's liver was damaged because of alcoholism and she had not stopped drinking should the insurance company be obligated to provide her with a liver transplant?

 

[Jon-Marc]

Not at all surprising since money to many (especially insurance companies) is more important than human lives. The first thing I am asked when I go to doctor or a hospital is for my insurance card. I'm tempted to say the next time that I don't have insurance just to see what they would do.

I had a brother who took his little boy to several hospitals after the boy fell and injured his head. Not one of them would accept him because of my brother not having any insurance, and that was about 30 years ago. The insurance companies are even more greedy and uncaring now.

 

[FR7 Baptist]

Paul, if this woman's liver was damaged because of alcoholism and she had not stopped drinking should the insurance company be obligated to provide her with a liver transplant?

That would depend on her contract with her insurance company. I'm a supporter of single payer healthcare, and I'd propose in that plan that a liver transplant should not be paid for if the patient has an active alcohol abuse problem.

 

[annsni]

This seems to be an issue with the insurer, not the hospital.

It had nothing to do with the insurer because the family is loaded and was willing to pay the full amount themselves. I understood it had to do with the transplant guidelines.

 

[targus]

That would depend on her contract with her insurance company. I'm a supporter of single payer healthcare, and I'd propose in that plan that a liver transplant should not be paid for if the patient has an active alcohol abuse problem.

Then absent the details of this case aren't you a bit premature in your declaration that the insurance company is profits before people?

 

[Don]

Then absent the details of this case aren't you a bit premature in your declaration that the insurance company is profits before people?

In a word: Bingo.

 

[matt wade]

Then absent the details of this case aren't you a bit premature in your declaration that the insurance company is profits before people?

And isn't it interesting that the patient and family are unwilling to disclose the reason for liver disease? Seriously, if she had contacted liver disease through some natural means (as opposed to a sinful lifestyle), why wouldn't they say so?

 

[freeatlast]

There should never be a case where medical treatment is withheld because of how an ailment came about. Since most injuries are from carelessness then most of us would not be treated. However that being said in cases like this since there are limited number of resources and it is clear that the patient would only receive the treatment and it would go to waste then someone else who shows that they would use the treatment correctly should be considered first. If there was an aboundance of livers this person should have received one rather then let the liver go to waste.
Now in the case of insurance companies we all know that they base their choices on the bottom line and that is what should be against the law.

 

[targus]

Now in the case of insurance companies we all know that they base their choices on the bottom line and that is what should be against the law.

We all know that do we?

Actually the contract dictates the services provided.

 

[freeatlast]

We all know that do we?

Actually the contract dictates the services provided.

I clearly stand corrected, not all.
While your statement is true about the contracts it is also deceptive. Insurance companies have in their contracts that which gives them the right to deny certain coverage's as they see fit. It is not always cut and dry. In the case of the OP I am not sure why they denied the transplant, but if it was not forbidden for all it should not have been forbidden at all. The hospital and Doctors should have been the ones deciding if this person was eligible not an insurance company.

 

[targus]

In the case of the OP I am not sure why they denied the transplant, but if it was not forbidden for all it should not have been forbidden at all. The hospital and Doctors should have been the ones deciding if this person was eligible not an insurance company.

So there is no imaginable circumstance where by an insurance company should not be required to pay for repeated treatments for an insured that continues to self inflict the problem requiring the treatment?

 

[Robert Snow]

My best friend spent two years waiting for new liver, which he finally received about two months ago. During the time he was waiting the hospital did regular blood tests. The policy was that the people on the list were not allowed to use alcohol or any illegal drugs. If they tested positive they were removed from the list and then tested again after six months. If clean they were then put back on the list. It is also his understanding that if they tested positive again they were removed from the list permanently.

 

[carpro]

My best friend spent two years waiting for new liver, which he finally received about two months ago. During the time he was waiting the hospital did regular blood tests. The policy was that the people on the list were not allowed to use alcohol or any illegal drugs. If they tested positive they were removed from the list and then tested again after six months. If clean they were then put back on the list. It is also his understanding that if they tested positive again they were removed from the list permanently.

That would be the "donor" list.

Which no insurance company has any control over whatsoever.

 

[John Toppass]

That would be the "donor" list.

Which no insurance company has any control over whatsoever.

Nope, it is the transplant list. It is not like they have an overage of livers. Why should they use one on someone who abuses themselves or has an incurable disease when there are many others who are follow the rules?

If you are going to abuse your body, save your money to pay for the damage you cause. This includes those who with head injuries who choose to ride motorcycles without a helmet

 

[freeatlast]

So there is no imaginable circumstance where by an insurance company should not be required to pay for repeated treatments for an insured that continues to self inflict the problem requiring the treatment?

That is correct. If the premium is paid and there is no clear statement in the policy as to when a treatment will not be paid then they should have to pay or not write the policy. It would be no different if a person was a bad driver. As long as they have wrecks and a policy in effect the insurance should have to pay. The alternative is to not insure the bad driver or raise the rates in accord with the drivers record, but not to deny a claim once premiums are paid. Some people have several drunk driving wrecks and if insured the insurance company still has to pay up. The same should be with medical insurance.

 

[carpro]

Nope, it is the transplant list. It is not like they have an overage of livers. Why should they use one on someone who abuses themselves or has an incurable disease when there are many others who are follow the rules?

If you are going to abuse your body, save your money to pay for the damage you cause. This includes those who with head injuries who choose to ride motorcycles without a helmet

I misspoke. Transplant list is what I meant. :tonofbricks: