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Kaiser Permanente Patient Horror Story
 

Mary Cromwell
Alameda, CA
 

HMO DENIES LUNG TRANSPLANT, PATIENT TOLD TO LAUNCH FUNDRAISING CAMPAIGN FOR LIFE SAVING CARE

In 1991, a year after my daughter was born, I was diagnosed with a terminal lung disorder, Pulmonary Hypertension, and given 2 years to live. I was referred to a major teaching hospital for a lung evaluation. It was determined that I would be a suitable candidate for a lung transplant and I was accepted into their program.

This gave our family hope. This hope was subsequently dashed when my HMO denied coverage because I also suffer from Lupus (an autoimmune disorder) which in my case was mild. This denial of life saving care was done by a HMO appointed doctor who never saw me, who disregarded the opinion of my primary care physician, who never spoke to the teaching hospital, and who never requested a copy of my medical transcripts.

I appealed this decision and was stalled for several months. I was frustrated, desperate and outraged. The HMO was ignoring the recommendation of a major and well respected institution. I had spoken to a woman in Los Angeles with the exact same condition whose insurance company had provided coverage. I called the state insurance commissioners' office and was told that this situation came under the Department of Corporations, and again I received little response. It was suggested that I begin to fundraise. I was trying to cope with a terminal illness, hold a job down, raise a baby and now fundraise!

I eventually garnered letters of support from major transplant organizations in the United States and England. My Congress member was kind enough to advocate for me. Local television news ran an item on my situation. The HMO, secondary to all this public pressure, relented, but at what cost to me and my family? Why was I , the one who needed support, doing all the work here? I was subsequently successfully transplanted and have enjoyed two healthy years since.
 

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