Man denied transplant because of insurance cap policy

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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.

There's no price on life, is what I keep saying. That's what everyone says.

–Clark Kimble

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.


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John Daley


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