For transplant patients—or anyone who anticipates a very expensive surgery—the following tips may help with the financial burden and prevent unnecessary expenses.
The initial testing required for a patient to be placed on a waiting list for a transplant or to be cleared for surgery can alone cost tens of thousands of dollars, even if the patient is not hospitalized during the process.
It is not uncommon for the cost of major surgery and subsequent extended hospitalization to result in a bill that exceeds $500,000. Unfortunately, the expenses do not end with surgery; the cost of medications in the year after surgery can be thousands of dollars a month.
Ideally, a patient will have primary insurance to pay the majority of the expenses and a secondary form of insurance to pay the remaining expenses.
Hospitalization required before surgeryTreatment costs prior to surgery, such as dialysis and insulin pumpsTransplant surgery and hospitalizationAnti-rejection medicationsOngoing visits with the transplant surgeonAny additional treatment requiredInsurance deductibles, co-pays, and premiumsNon-medical expenses, including childcare, travel, and lodgingLost wages
Depending on your plan, private insurance may assume a good portion of the total cost of an organ transplant. However, most insurance plans have a maximum or “cap” on the amount that the company will pay. This cap may be met or exceeded in the standard care provided during the course of an organ transplant.
COBRA is an example of private insurance that is obtained outside of the workplace; the patient pays the insurance premium.
This type of government-funded insurance pays for transplants, but not everyone qualifies for coverage. It also pays for many other types of surgery, if the procedure is deemed necessary.
Patients age 65 and older, patients younger than 65 with certain disabilities, and those who have been diagnosed with end-stage renal disease qualify for Medicare. Additionally, patients may qualify if they or their spouse have paid into the Medicare system. The Medicare website www.medicare.gov provides detailed information about qualifying for coverage, and what coverage is available in each state.
Medicaid
Medicaid is government-sponsored insurance for low-income patients that is administered by individual states within federal guidelines. Medicaid coverage qualifications vary from state to state. The income limit to qualify is based on the size of the family and income level, but a patient with a low income does not necessarily qualify automatically for coverage.
A financial planner at your transplant center should be able to help you navigate the process of dealing with Medicaid.
The TRICARE website is an excellent resource for patients and families who have questions about coverage.
This is not uncommon, and many patients explore other options to help them fund their procedure.
Some patients have great success with online fundraising, using websites such as GoFundMe.com to share their story.
