Friday, May 7, 2010

Super Clark on KSL

Man denied transplant because of insurance cap policy
May 6th, 2010 @ 6:14pm By John Daley

SARATOGA SPRINGS -- Friends and family are getting organized to help a man from Saratoga Springs who is afflicted with a rare disease.

His situation is complicated by the fact he's maxed out on his lifetime insurance coverage, and he isn't sure Medicaid will cover much-needed bone marrow treatment.

Many employers place a cap on lifetime insurance coverage. But what happens if you get sick and your costs exceed that number?

Clark Kimble had a good job, with insurance, with a cell tower construction company. Then last summer he came down with a rare virus and needed a life-saving liver transplant and multiple surgeries.

The cost exceeded his lifetime insurance limit.

"Humana, you know, they've been great, but there's a $2 million lifetime max with my transplants," Kimble said. "I've had 18 surgeries, all the transfusions."

Humana couldn't officially discuss Kimble's case, but said, "Depending on the product an employer purchases from Humana, an insurance policy may have a maximum lifetime benefit."

Now on Medicaid, Kimble needs a bone marrow transplant. He says he's been denied twice by Medicaid because it's considered a risky procedure.

"There's no price on life, is what I keep saying. That's what everyone says. But it's like, how can they say you're 24, you have a life ahead of you still. It's very frustrating," Kimble said.

The state agency that determines eligibility says Kimble missed a deadline to apply for social security disability, which is needed to pay for further treatment.

"He has until the end of the month that he can go visit social security, apply for the disability benefit and provide verification," said Dave Lewis, communications director of the Utah Department of Workforce Services. "We can reopen the case, no loss in coverage."

In the meantime, family and friends are rallying around the guy they call Super Clark, putting up a blog, raising money and urging Medicaid to cover the bone marrow procedure.

Kimble's sister Kristin Purles said, "We get e-mails and comments on the blog and texts and phone calls regularly saying how much he has changed people's lives, and they don't even know him personally."

Federal health reform will get rid of that lifetime limit. Kimble and his family are appealing Medicaid's decision. They say his whole medical team will be making the case on his behalf for the bone marrow transplant at a hearing next week.

5 comments:

Tasha said...

I am so glad he was able to share his story! I love the princess bandaid as well:)

Caitlin said...

Hi!
My name is Caitlin and I'm a student at the University of Connecticut. I donated bone marrow this past February and I've been keeping up on news about bone marrow since then. I came across this blog, and I wanted to say how much I admire this effort and your fight. This is amazing and inspiring. I have a little blog about bone marrow issues, so I wrote a story about your effort and I hope that's okay. I made sure to link to your blog so people can read more. I hope it helps a little!
God bless!

laura neville said...

do not give up- Never! Your fight is so important for all of the people who are experiencing the insurance coverage denial ( and yes, I know that this is specifically medicaid!) and struggling with a serious illness.

Clark- you are an inspiration...as well as your family and friends who clearly demonstrate the meaning of "love"...
From kansas wishing you the best-
Laura Neville

Mills said...

Thinking of you Clark and all your family today, hope the Medicaid decision goes well and they TRULY think with their hearts this time. What is this were their son, daughter, niece, nephew.

shelly said...

The radio station in Ortonville would like a copy of this story sent to them they would like to run it.