Fred Watley rode a bike this summer. He rollerskates with his son. A couple of weeks ago, he shoveled snow until his wife shooed him back inside their Spokane home.
For a man lying near-dead in Sacred Heart Medical Center nine months ago and in need of a liver transplant, no day living should be wasted.
“I’m all about putting one foot in front of the other and just doing what you got to do,” said Watley, a man who shies from attention. “My biggest concern was to get this thing done so I can take care of my family.”
His story, however, is no private matter and is poised to help change state insurance law concerning organ transplants when the Washington legislature convenes this month.
Watley was thrust into the public health insurance discussion when he nearly missed his chance for a life-saving liver transplant because of an insurance coverage loophole.
Washington law allows health insurers to exclude organ transplant coverage for at least six months when people or employers – as was the case with Watley – change carriers.
So when his employer of 11 years, The Healing Lodge of the Seven Nations, switched to Group Health Cooperative a year ago, Watley’s status on the liver transplant list was suspended for six months.
Insurers use these waiting periods as financial protection against people who enroll in health plans without disclosing pre-existing conditions to receive immediate medical treatment.
As Watley’s condition worsened and he was still several months away from the resumption of his coverage, the loophole cinched into a trap.
His wife, LiAnne Watley, fought back – determined to make sure her husband lived to help raise their son, an 11-year-old who idolizes his dad and beams when he talks of rollerskating with him at Pattison’s North Skating Rink.
She thumbed through the Yellow Pages for a lawyer. Rejected four times, she finally found Brian Sheldon, who counseled her to share her story with The Spokesman-Review while he prepared emergency legal action.
When Watley’s ordeal reached top executives at Group Health, their response was quick and decisive.
“When I first heard about it I was just astonished,” said Pam MacEwan, Group Health’s executive vice president of public affairs and governance. “Here we had somebody who had been paying their premiums all along and playing by the rules and then suddenly they could be thrown for a loop. That just wasn’t right.”
MacEwan said she and a team at Group Health reviewed the laws, concluded they were wrong, and brought a recommendation to Chief Executive Officer Scott Armstrong. Group Health’s medical staff also pushed to cover Watley’s liver transplant at the University of Washington Medical Center, a procedure that typically costs about $500,000.
Within two days Armstrong set aside insurance policy and approved Watley’s transplant.
At the same time, the Seattle-based insurance company began working with Washington Insurance Commissioner Mike Kreidler to change the law.
A bill has been drafted that would eliminate extended waiting periods for organ transplant patients, such as the six-month wait that nearly denied Watley a new liver when his employer changed carriers, said insurance commission spokeswoman Stephanie Marquis.
The bill would require health insurers to “reduce any organ transplant benefit waiting period by the amount of time a covered person had prior creditable coverage,” and would take effect for policies issued or renewed on or after Jan. 1, 2010.
While his story might help spur changes in the law, Watley’s recovery has not been easy.
He has days when he doesn’t feel well, when the side effects of seven medications make him itchy, or tired. And he is dismayed that he lost his strength to jump high when playing basketball.
“Mostly I’m feeling pretty good,” he said during a recent rough day. “Sometimes, I guess, I’m down in the dumps with nausea.”
He blames a hair-trigger temper on the medications, then quickly credits LiAnne and his son for sticking with him.
“I am thankful for them, and also for what they have done to hopefully change the law so it won’t happen to somebody else.”
And the family has been affected, like most, by the recent economic downturn.
Both are still working, although they have had reductions in pay and hours.
“We live simple,” LiAnne said. “We don’t need a lot.”
LiAnne said she has learned how to fend for herself and accept the help of others.
“I know about survival,” she said, “how to dig in and fight like a bulldog.”