Dying man’s new insurer won’t cover a liver transplant

Fred Watley is missing his chance for a liver transplant.

A new organ may have helped the 59-year-old substance abuse counselor steer more teens away from drugs and booze; may have helped him raise his 10-year-old son into a young man; may have helped him grow old with LiAnne, his wife of 11 years.

None of that is likely.

Just as Watley’s liver ailments turned critical and his name neared the top of the waiting list, his employer was finishing negotiations with a new health insurance carrier that included a coverage catch: a six-month exclusion for organ transplants that began Jan. 1.

Watley and his family learned about the exclusion weeks after the new coverage began. They were devastated.

“We didn’t know until it was too late,” LiAnne Watley said.

The changes were agreed to by The Healing Lodge of the Seven Nations, a collaboration of Pacific Northwest tribes to treat teen substance abuse and mental health problems.

Watley has been waiting for several years for a new liver as cirrhosis and hepatitis C ravaged his own.

Last autumn, his condition worsened. His health has been in a free-fall for the past several weeks.

His physician, Dr. Mark E. Didier, wrote to Watley’s new insurer, Group Health Cooperative, urging it to make an exception and allow surgeons at the University of Washington Medical Center to perform a liver transplant.

“His hepatologist, Dr. Philip Delich, does not believe that Mr. Watley will survive until the planned July transplantation date. I must echo his concerns,” Didier wrote last week.

Watley suffered a crippling stroke Tuesday morning. His kidneys are shutting down as his body succumbs.

Watley won’t live much longer, Dr. Radica Alicic, of Sacred Heart Medical Center, told LiAnne Watley in an intensive care unit hallway. “I’m so sorry,” she told her.

Liver transplants cost between $350,000 and $500,000. The high expense leads some insurers to use temporary exclusions to ensure they are not saddled with cases that should have been handled by previous carriers.

The expense also makes hospitals and doctors reluctant, if not unable, to write off the surgeries as charity care. The UW Medical Center’s Liver Transplant Selection Committee notified Watley that his transplant status had been put on hold as of Feb. 21, after the insurance issues were vetted.

The committee informed him of other options, including with other transplant centers.

‘Standard mechanism’

Group Health denied Watley coverage of the transplant, citing the exclusion period, in a letter dated Feb. 19.

“The wait period is a standard mechanism so that a health carrier isn’t hit with information that might have been known previously,” Mike Foley, a Group Health spokesman, said later.

Executives at The Healing Lodge didn’t return a phone message seeking comment Tuesday evening.

Brian Sheldon, an attorney hired by the Watleys to navigate Group Health’s internal appeals process and perhaps press a lawsuit, said people should be aware of the consequences when their employers switch coverage plans.

“This happens more often than you might imagine,” Sheldon said. “It’s wrong. We believe people are entitled to a continuity of coverage.”

State regulators acknowledged that wait periods are common.

“They’re not discriminatory, because the rules apply to everyone,” said Bill Ripple, spokesman for Washington Insurance Commissioner Mike Kreidler. “Unfortunately that doesn’t help this gentleman.”

Making a difference

Watley had helped hundreds of teens beat drug and alcohol addiction while working for 11 years as a counselor with The Healing Lodge.

The treatment centers receive federal funds through Indian Health Services and state dollars from the Department of Alcohol and Substance Abuse.

Watley loves his work and the differences he can make in people’s lives, LiAnne Watley said. Her husband struggled with drugs and alcohol in the past, she said.

“The past is what it was,” she said, weeping. “We were all about looking forward.”

“And he loves his son more than anything in this world. That was his joy.”