Even though the father of two was registered under the state registry for a transplant and was promised an organ soon, his family had to arrange money for his treatment as his insurance would cover barely 25% of the expenditure.
Stephen, like many others, was not eligible to be covered under the Chief Minister’s Health Insurance Scheme (CMHIS) which only funds complete treatment of families that fall below the poverty line.
“The government scheme can only cover a part of the treatment cost, patients have to bear the rest,” said Dr Joseph Amalorpavanathan, former convener of the state Transplant Authority TRANSTAN on World Donation Day.
“While the government should prioritise preventing organ failures, it should also help those who need funds for transplants. The government could achieve this easily if they partner with private insurance companies,” said Dr Sunil Shroff of NGO Multi Organ Harvesting Aid Network (MOHAN) Foundation which promotes organ donation and transplantation.
Over 1.5 crore families are covered under the health insurance scheme, under which, 384 transplants worth Rs 548.38 crore have been approved. The state has also created Rs 35 crore for cases where the cost of surgery exceeds the insurance cover of Rs 1.5 lakh, said health minister Dr C Vijaya Baskar.
An analysis of the scheme’s beneficiaries over five years showed that kidney transplants topped the list among organ transplants. It was followed by liver and bone marrow transplants. “Organ transplants are quite expensive and data from the analysis showed that there were a significant number of patients, only a fraction of whose medical costs were covered by the insurance,” said Sasikumar Adidamu, chief technical officer of the insurance company.
City nephrologist Dr Anna A said, “It helps when the government helps people in terms of health insurance but it would be better for the people if they buy health insurance policies with larger premium amounts so that most of their medical expenditure is covered by the insurance.”
Insurance firms must come forward to support organ donors: Doctors
Kidney donor Dr Ravi Wankhede, 67, was denied health insurance twice as the companies felt that as an organ donor, he was more prone to health risks.
Dr Sunil Shroff of Multi Organ Harvesting Aid Network (MOHAN) Foundation, an NGO that promotes organ donation and transplantation, said that such cases were not rare. “Organ donors are as healthy as any other human being and should not be denied the right to avail of insurance.”
“After collecting my premium amount, an insurance company said that they could not cover me but did not state any reason for it,” said Wankhede.
“I suspected that they rejected me because of my age. I then approached another company and faced rejection again. When I asked them the reason, they said that since I was a kidney donor, I had more medical risks so they could not insure me,” he said.
Dr Shroff said, “Most donors experience similar situations. But the companies should know that organ donors are as healthy as non-donors. They should not be denied a health insurance just because they saved somebody else’s life,” he added.
But not all companies work the same way, said chief technical officer of Bajaj Allianz General Insurance company Sasikumar Adidamu. “We receive applications from a number of organ donors and we never reject them on the basis of their donation,” he said.