Outrage: Man's Health Insurance Is Holding His Liver Transplant Hostage [View all]

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http://www.alternet.org/outrage-mans-health-insurance-holding-his-liver-transplant-hostage

In January of this year, Dan Reesor, a deputy district attorney in Deschutes County, Oregon, was diagnosed with liver cancer and inflammatory liver disease. Doctors at the University of California Los Angeles told him the combination was fatal, and that a liver transplant is best way to save his life. The liver transplant waiting list has roughly 16,000 people on it, although the sickest are prioritized. But perhaps the greater hurdle to treatment is the financial cost of the procedure: $1.4 million.

As a county employee, Reesor has health insurance. But while Deschutes County is self-insured, it uses an independent administrator, the Montana-based Employee Benefit Management Services, to review claims submitted from employees. EBMS bills itself as “one of the nation’s premier industry leaders in health risk management and third party administration of self-funded health benefit plans, designing strategies to transform the health and wellbeing of individuals, organizations and communities.” Its internal newsletter paints a happy picture of a company that values its employees, works to promote worksite health, and holds a raucous annual client appreciation event featuring, among other things, rafting and rapping.

But EBMS is fundamentally a for-profit entity designed to save its clients money, and in this case the client is Deschutes County. When Reesor approached EBMS about his liver transplant, they flatly denied it, telling him his transplant was both “experimental” and not “medically necessary.” A doctor working for EBMS apparently derived all this from just reading about Reesor; he never met with him. “Basically he's only seen me on paper. So EBMS hires this one doctor who basically determines whether I live or die,” Reesor told local television station KTVZ.

Reesor and his wife Jo are doing everything they can to get the transplant funded. They have set up a website letdanlive.com that seeks to do two things. First, they hope to fundraise with a GoFundMe account; if they can reach $700,000, Reesor will be placed on the transplant list. Second, they are petitioning Deschutes County's three commissioner board members to require the county insurance to cover the transplant. None of the three commissioners replied to request for comment from AlterNet, and have declined to comment to local media.