Idaho couple refused in-network coverage for kidney disease

2.25.16

An Idaho couple is among the latest cases of blatant patient discrimination by insurance companies.

Gary and Debbie Birch, who operate a family farm near Caldwell, Idaho, hope the state insurance division will take up the issue after their insurer, Blue Cross of Idaho, eliminated all dialysis providers in the state from being in-network.

That means anyone in Idaho needing kidney dialysis could have to pay hundreds of thousands of dollars more each year for these life-saving treatments – or be forced to switch to Medicare, where they won’t get the same level of coverage and overall benefits.

Debbie Birch was diagnosed last year with end-stage renal disease, requiring her to have regular dialysis treatments to live. The diagnosis was already difficult enough. The insurance woes – and possible financial impact on her life and the family farm – only add to the trauma.

“I’ve been very depressed,” she said. “It took the hope out of my future.”

Gary Birch said he was particularly disturbed about Blue Cross not communicating with the couple about drastic changes in their plan.

“There are people out there like us who don’t even know this is happening,” he said.

When Debbie was first diagnosed, the couple sought treatments for her at a Fresenius clinic. As a member of Blue Cross, she thought she had access to this essential health benefit within the network of providers. Unfortunately, the Fresenius clinic was not part of her in-network benefits with Blue Cross, and she accrued $150,000 in extra costs not covered by insurance. After discovering on her own that Fresenius wasn’t covered, she switched to a DaVita clinic.

Then Blue Cross dropped DaVita from its network too. The Birches learned about that change not from Blue Cross, the insurer they pay for coverage, but from DaVita, the clinic. When they called their insurance company about the situation, Blue Cross Idaho told the Birches that they had no option for an in-network dialysis clinic in Idaho. Their only option was to switch to Medicare, even though that would deprive them of much of the other coverage they had when paying for their insurance through Blue Cross.

The Chronic Disease Coalition is an advocacy organization that is against this kind of patient discrimination. Please join us and help to advocate for the Birches, and for hundreds of other kidney patients in Idaho who are seeing their lives placed at risk by unconscionable insurance practices. Click here to sign up for updates on this story as it develops.