Her kidney is ‘just done’. But insurance giant Kaiser balked at life-saving surgery

May 30--Corinne Cline of Modesto says she's not a fighter by nature.

But her recent battle against a health insurance titan has attracted the attention of politicians. Cline needs a lifesaving surgery to remove a chronically infected kidney that puts her at risk of dying from sepsis.

"They are making decisions based on dollars and cents," Cline says.

Cline, 37, had major surgery as a baby because of a birth defect that bypassed the ureter around her right kidney. She endured chronic kidney infections and countless rounds of antibiotics during her early life and struggled with the kidney through miscarriages and successful pregnancies.

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She says a recent infection in March made her seriously ill, resulting in 13 emergency-room visits in the past two months. Doctors at University of California San Francisco told her she needs to have the kidney removed. She and her family have been battling Kaiser Permanente to approve coverage for the surgery and pay for recent procedures at UCSF costing hundreds of thousands of dollars.

"The kidney is just done," says Cline, who was given a nephrostomy bag to drain the organ. "It has lasted way longer than they ever thought."

Chad Cline, her husband, filed a grievance with Kaiser on Friday. The Clines believe Kaiser started to respond early this week because Assemblyman Heath Flora, R-Ripon, and county Supervisor Kristin Olsen, a former assemblywoman, made inquiries on their behalf.

Flora confirmed he advocated for the family by sending texts over the Memorial Day weekend. He suspects the family was being "slow-rolled" by the Oakland-based insurer, which operates a large network of hospitals, pharmacies and clinical offices for members.

"I think the process is working," Flora says. "Their local representatives have been very responsive in fixing the immediate problem. ... Once we are making sure Corinne is taken care of, there are a few more questions we will have."

Kaiser released a statement Wednesday attributed to Corwin Harper, senior vice president and area manager for Kaiser Permanente Central Valley. "Our priority is Ms. Cline's health and well-being," Harper says. "We have been and are continuing to work closely with her and her family to provide the care and support she needs."

According to the statement, Kaiser encourages its members and patients to engage with their clinicians to discuss their treatment options. Kaiser health plan members have access to formal processes for appeal and review. "Kaiser Permanente covers the cost of authorized care received by members, including at contracted facilities, in accordance with the member's health plan coverage," Harper says.

The Cline family has appealed Kaiser's denial of claims for the recent care at UCSF to the California Insurance Board. Corinne needed hospital care at UCSF, including insertion of the nephrostomy bag, to prepare for removal of the kidney.

Corinne says her first choice for performing the difficult surgery was Dr. Thomas Chi of UCSF. Because of her extensive medical issues since childhood, scar tissue has cemented organs to organs in her body and the kidney adheres to her colon, she says.

Early this week, Kaiser offered a highly trained surgeon, Dr. Jared Whitson, who used to work with Chi at UCSF. That gave her the option of a surgery with Chi on June 6 or Whitson in Sacramento on June 5.

As a devout Christian, Cline prayed hard about the decision, and she took Chad's advice to write down the pros and cons. After she and Chad had a video conference with Whitson on Tuesday, Cline chose a robotic-assisted surgery with Whitson, the Kaiser specialist.

Kaiser will cover the 5-hour operation. The Clines felt more confident when Chi vouched for his former colleague's skills.

Corinne says people have contacted her and told heart-wrenching stories of losing loved ones who could not get treatment for complex medical needs. "People have said they have been in my shoes," Cline says. "That is how the system is. You have to fight for proper care."

Cline has missed recent family events, such as her son and daughter's kindergarten graduation, but hopes the operation will restore her life as a mom and piano teacher.

"If the kidney is taken out, I am told I will feel like my life was given back," Cline says. "I should feel like a brand new person."

Chad Cline has his own view of his wife's fighting spirit. "We are both of the mindset that we should be able to trust whatever system we are part of," Chad says. "We felt we were let down. We are fortunate to have family, friends and connections to help us through this, but what about those without connections?"

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