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Lambda Legal Presses 12 Leading Health Insurance Companies To Issue Clear Policies on Covering Organ Transplants for Patients with HIV

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'We are hearing from more and more people with HIV who are being denied life-saving transplants, despite medical and scientific standards. These insurance companies have a duty to clearly tell people where they stand.'
November 30, 2004

(New York, Tuesday, Nov. 30, 2004) – With many people with HIV living longer lives and having more complex medical needs, Lambda Legal said today that it is pushing the nation’s largest health insurance providers to release any policies they have on covering life-saving organ transplants for patients with HIV. Lambda Legal’s HIV Project has worked with a number of people who were denied coverage for transplants simply because they have HIV – even though more than a decade of scientific and medical research shows that organ transplants for people with HIV are effective and safe. People with HIV are often in greater need of transplants because they have much higher rates of Hepatitis-C. With transplants, they often live full and healthy lives. Lambda Legal sent letters earlier this month to 12 of the nation’s top health insurance companies, asking for copies of their policies on covering transplants for people with HIV. The companies are Assurant, Aetna, Aflac, Anthem, BlueCare, Cigna, Healthnet, Humana, PacifiCare, United Health, Wellpoint and Wellchoice. None have responded with existing or new policies. “HIV itself isn’t necessarily a death sentence any more – but it becomes one when health insurance companies refuse to let people have the transplants they desperately need,” said Kevin Cathcart, Executive Director of Lambda Legal. “We are hearing from more and more people with HIV who are being denied life-saving transplants, despite medical and scientific standards. These insurance companies have a duty to clearly tell people where they stand.” Cathcart said the case of William Jean Gough, a 46-year-old Pennsylvania man with HIV and Hepatitis-C, starkly illustrates the urgency of securing clear policies from insurance companies. Gough was denied a liver transplant last year – even though he had been accepted as a candidate by the transplant team at the renowned Thomas E. Starzl Transplant Institute -- because Medicaid said the procedure was not “medically necessary.” Gough suffered from advanced liver disease that was often debilitating. Lambda Legal appealed on his behalf, and an administrative law judge reversed the decision within days. “William Jean Gough got a new liver eight months ago, and he might not be alive today without it,” Cathcart said. Gough is recovering well. “It wasn’t the HIV that was killing me – it was the Hepatitis-C,” said Gough. “I’ve been lucky enough to be resistant to HIV and it hasn’t hindered my life. But the liver damage from the Hepatitis nearly ended my life. Without a transplant, I doubt I would be here today. It’s unbelievable to me that some insurance companies won’t cover these transplants, and that some won’t tell patients whether they’ll be covered.” Weeks before winning Gough’s appeal, Lambda Legal also persuaded Kaiser Permanente to overturn its decision denying a kidney transplant for a Colorado man with HIV. Lambda Legal had filed a formal appeal with Kaiser Permanente, asking the HMO to reverse its denial in light of a range of scientific data and client John Carl’s personal health history and experience. Lambda Legal cited mainstream medical journals that show “no evidence of poorer survival among otherwise healthy HIV-positive patients who are receiving anti-retroviral therapy.” The articles conclude that “transplantation in HIV-positive patients should … not be considered experimental.” Carl, a Denver area resident, has lived with HIV for nearly 15 years. "While I am very grateful that Kaiser Permanente eventually made the decision to evaluate my eligibility for a transplant, I urge Kaiser to establish a policy to evaluate all people with HIV on a case-by-case basis, just like they do with everyone else. Delays lead to lost transplant opportunities that many of us just can't afford," Carl said. “We have no idea exactly how many other people with HIV are in William and John’s situation, but we know that these insurance companies have millions of customers,” Cathcart said. “We are determined to get these insurance companies on record so that people with HIV know whether they’ll be covered when their lives depend on it – and so that the public knows just where these companies stand.” ### The letter to the insurance companies, along with a fact sheet on organ transplants and people with HIV, is on Lambda Legal’s home page at www.lambdalegal.org. About Lambda Legal’s HIV Project Lambda Legal was founded in 1973 to advance the civil rights of lesbian, gay, bisexual and transgender people, and began working on behalf of people with HIV at the onset of the epidemic in the 1980s. Lambda Legal filed the first HIV discrimination case in the nation in 1983, and later successfully forced hospitals to treat people with HIV and pushed prescription drug companies to lower the cost of HIV and AIDS treatments. Lambda Legal’s HIV Project has won critical victories on behalf of people with HIV to be treated equally and with dignity in employment, medical services, public accommodations, parenting and other areas of life.

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