Word: transplanting
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Dates: during 1990-1999
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...MUSC, Hunter became a patient of Dr. Adrian Rubin, who agreed with the Greenville doctor that Hunter needed a new liver but who also recognized that insurance was very much a factor. Rubin consulted with the hospital's financial staff, which confirmed that MUSC did not have a liver-transplant contract with Hunter's carrier, Physician's Health Plan. But, Rubin was told, Duke, where he knew the liver people, did have a PHP contract. So the physician recommended that Hunter go there. Rubin placed a call to Duke hepatologist James Trotter, explaining that he had a seriously ill transplant...
SEPT. 3 A phone call from Joe Robbins, a Duke financial coordinator, to Jackie Brown, PHP's transplant coordinator, was the first anyone at the insurance company knew of Hunter's whereabouts. Both recognized that the patient was "out of network," but it would be weeks before anyone would sort out how it was that Hunter ended up in a hospital with no plan to pay for an operation that could cost anywhere from $80,000, if the procedure went smoothly, to perhaps $1 million, if complications arose. The precipitating error apparently took place in the back offices of MUSC...
...patient could stay at Duke through the weekend, but if he stabilized during that time, PHP wanted him flown to Tuscaloosa, Ala., on Tuesday. O'Connor also told Trotter, according to the insurer, that if Hunter's condition worsened over the weekend, Duke was "authorized" to perform a transplant...
Moreover, opponents say, the new system could actually drive up costs. Sicker patients require more expensive follow-up care than average patients do, and they have a lower overall chance of survival. Officials at major transplant centers also point out that they are not the only ones open to charges of greed: small transplant centers would probably lose patients and income under the new regulations...
...this political wrangling leaves potential transplant patients in limbo, adding uncertainty to the anguish they already suffer. Like Bryan Lee, Rita May Bolen has had enough. From her home in a New Orleans suburb, she calmly says her husband Leon, 71, is "sitting in a chair dying." They have been waiting 10 months for a liver. In August Leon was second in line for an organ that was about to become available, but it went to a sicker patient, a young father. "It's the fairest way," says Rita May. But watching the debate over regulatory changes--which could have...