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Insurance policy delays man’s life-saving transplant

<i>WLWT</i><br/>A Kenwood man's search for a life-saving lung transplant is complicated by figuring out how to pay for it.
A Kenwood man's search for a life-saving lung transplant is complicated by figuring out how to pay for it.

By Katara McGee

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    CINCINNATI, Ohio (WLWT) — A Kenwood man’s search for a life-saving lung transplant is complicated by figuring out how to pay for it.

Last winter, 55-year-old Mark Plummer was healthy. He was employed as a delivery driver and said he’d never even had surgery or a broken bone.

In February 2021, he started experiencing shortness of breath. By May, he was diagnosed with interstitial lung disease.

Four words in his front yard give passersby a sense of the mountain he is facing. A sign reads, “We believe in miracles.”

“It’s a scarring of the lungs, it’s progressive and it’s incurable,” Mark Plummer said. “This is a progressive disease and there’s only two outcomes. It’s either you get a lung transplant and hopefully survive or eventually, I’m gonna pass away.”

The disease causes stiffness in the lungs, making it difficult to breathe or get oxygen to the bloodstream.

“It is something I would not want my worst enemy to have to go through,” Linda Plummer said.

Her husband is on oxygen 24 hours a day. They learned he would need a transplant to survive several months ago.

Mark Plummer completed all the required pre-transplant testing and was told by his doctors at Ohio State’s Wexner Medical Center that he was a perfect candidate for the transplant.

But a phone call a few weeks back about his insurance brought the Plummers to their knees.

“They have a clause in their policy that they do not cover organ transplantation,” Mark Plummer said. “I was devastated. After preparing myself mentally to have a double lung transplant, which is far from a minor procedure, I was crushed.”

When he got sick, Mark Plummer had just resigned from his delivery driver job at Klosterman Baking Company, preparing to start a new job. Then he ended up in the hospital, his condition worsened, and he never returned to work. He was disabled in a matter of weeks.

Under COBRA, a federal law, he was allowed to keep his employer-based coverage from Klosterman Baking Company at a higher cost. But the issue is Klosterman’s medical plan does not cover organ transplants.

Without insurance, the Plummers were told the estimated cost for a transplant and rehab is half a million dollars.

“Someone somewhere is playing God,” Mark Plummer said.

“This is so unfair. And it could happen to anybody,” Linda Plummer said.

The two were looking forward to retirement, spending their days taking walks around the neighborhood, going to concerts and traveling. Those plans are at risk, even if Mark Plummer receives a transplant and survives.

“We were going to have to liquidate our retirement funds. We had decided that if I’m not gonna live to enjoy the retirement funds, what’s the point?” he said.

Wexner Medical Center was able to get Mark Plummer listed on the transplant waiting list a few days ago. He is currently hospitalized on a high amount of oxygen and waiting for a transplant.

Linda Plummer tells WLWT that the finances are still up in the air, but they are hopeful.

The family set up an online fundraising page through the nonprofit Help Hope Live to raise funds for medical expenses. Donations are tax-deductible.

Klosterman Baking Company issued the following statement to WLWT.

“Klosterman Baking Company offers employer-sponsored health care to its associates, and in accordance to Consolidated Omnibus Budget Reconciliation Act (COBRA), the company offers former employees COBRA continuation coverage. This temporary extension of benefits is identical to the medical plan the individual received during their employment. Klosterman’ s employer-sponsored medical plan does not cover transplant procedures or related services for either current or former employees who choose to enroll in the COBRA plan.

“Any former plan participant has several options for healthcare coverage. They can enroll in coverage from their new employer; they can opt into COBRA coverage through Klosterman Baking Company; or they can shop for coverage on the Health Insurance Marketplace, where numerous plans are available with varying forms of coverage including transplant services. Employer-sponsored coverage from a current employer or from the Health Insurance Marketplace likely would be cheaper than the COBRA coverage provided by Klosterman.

“As always, Klosterman Baking Company is ready and willing to assist any plan participant in finding an appropriate plan and collaborating with current employers, the Health Insurance Marketplace or other programs like Medicaid if they are in need.”

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