INSURABILITY OF CHILDREN WITH CONGENITAL UROLOGICAL ANOMALIES

Purpose: We sought to determine life insurance underwriting practices for children diagnosed with multicystic dysplastic kidney ar unilatera l neonatal hydronephrosis, and evaluate whether management options (ob servation versus operative intervention) have an influence on such pra ctices. Materials and Methods: A questionnaire and history of 1 child with multicystic dysplastic kidney and 1 with unilateral neonatal hydr onephrosis were distributed to 348 insurance companies licensed to iss ue life insurance policies in New Jersey. The medical director of each insurance company was requested to indicate the current underwriting practices for life insurance policies based on these 2 case scenarios, and asked whether observation or operative intervention influenced su ch decisions. Results: Of the 348 insurance companies licensed to issu e life insurance 130 (37.4%) responded, including 5 (3.8%) that did no t choose to participate in the study, 56 (43.1%) that did not issue li fe insurance to children and 69 (53.1%) that completed the questionnai re based on current life insurance underwriting practices. For a child with multicystic dysplastic kidney 10 companies (14.5%) would issue l ife insurance if treatment involved observation only, while 49 (71%) w ould do so after nephrectomy. For a child with unilateral neonatal hyd ronephrosis 19 (27.5%) companies would issue life insurance if treatme nt involved observation only, while 46 (66.7%) would do so after pyelo plasty. Conclusions: Despite limited long-term data on and uncertainty about the natural course of multicystic dysplastic kidney and unilate ral neonatal hydronephrosis, treatment options offered a child with a congenital urological anomaly may have a significant impact on the abi lity to obtain life insurance. Children with multicystic dysplastic ki dney and unilateral neonatal hydronephrosis can usually obtain life in surance after early operative intervention (nephrectomy and pyeloplast y, respectively), although sometimes at higher cost.