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Patients in Washington State Protest 90-day Transplant Waiting Period

People in Washington state who recently purchased health plans via the state’s online exchange are finding that they need to wait 90 days from when their insurance begins before coverage for transplants will become effective...
January 28, 2014

People in Washington state who recently purchased health plans via the state’s online exchange are finding that they need to wait 90 days from when their insurance begins before coverage for transplants will become effective. The waiting periods apply only to those who did not have prior coverage. If a member had been continuously enrolled in a different plan 90 days prior to incurring the transplant-related expenses, he or she would be exempt. If a member had coverage for less than 90 days, the exclusion period is reduced by one day for each day of prior coverage.

Susanna Nazarian, assistant professor of transplant surgery at the University of Washington, said, “Putting this additional barrier in front of them will lead to some patients passing away.” Patient advocates have successfully pushed back against a similar provision in Oregon that allowed insurers to impose a 24-month waiting period for transplants. The insurance commissioner eliminated that rule on Dec. 31 and told insurers there should be no waiting period. The Affordable Care Act (ACA) prohibits “excessive” waiting periods which it defines as more than 90 days. But it does not indicate whether specific benefits could be subject to a waiting period, and state officials have interpreted the law in different ways.

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