February 6, 2009 in City

Liver recipient wants loophole in transplant coverage closed

Staff writer
 
RICHARD ROESLER photo

LiAnne Watley, left, speaks at a House hearing Wednesday in Olympia. Her husband, Fred Watley, was nearly denied a critical liver transplant due to a loophole in the law.
(Full-size photo)

OLYMPIA – Fred Watley’s need for a liver is changing state law.

A year ago, the Spokane man nearly died while waiting for an insurance-law loophole to expire so he could get the liver transplant he desperately needed. His insurer finally relented.

On Thursday, Watley – with a new liver – urged state lawmakers to close the loophole so that people no longer have to risk their lives waiting.

The near-tragedy prompted newly elected state Rep. John Driscoll, D-Spokane, to sponsor House Bill 1308, which would reduce the wait in such cases.

“I wasn’t planning to make history. I just wanted to save his life for our 11-year-old son,” said Watley’s wife, LiAnne.

The change is backed by Watley’s health insurer, Group Health, and other major health insurers in the state.

“It’s a loophole that needed to be cleared,” said state Insurance Commissioner Mike Kreidler, who said he was stunned to learn that when employers switch health plans it restarts the waiting period of at least six months allowed for organ transplants.

That’s what happened to Watley. For years, he’d worked as a substance abuse counselor for the Healing Lodge of the Seven Nations. The center switched to Group Health Cooperative in 2008. Watley, who’d been waiting for a liver transplant, was told that his status would be suspended for six months.

Insurers use such waiting periods to protect themselves against people who enroll in health plans without disclosing pre-existing conditions.

As Watley lay in a hospital room, The Spokesman-Review wrote about the case.

“This is a person who played by the rules,” Group Health executive vice president Pam MacEwan told lawmakers Thursday.

“He paid his premiums. He stayed covered.  … And yet when he needed the system, it wasn’t there for his because of this loophole.”

She said company officials were initially reluctant to change the policy for fear of creating a precedent. After discussing it, they decided to cover the transplant and push to narrow the loophole.

Richard Roesler can be reached at (360) 664-2598 or by e-mail at richr@spokesman.com.


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