Affording a Transplant
The following is an edited reprint of information compiled and created by the U.S. Government and which is featured on the site OrganDonor.gov.
Transplantation involves costs before, during, and after the actual transplant surgery. Costs include laboratory tests; transplant surgeons and other operating room personnel; organ procurement; in-hospital stay; transportation to and from the transplant hospital for surgery and for checkups; rehabilitation, including physical or occupational therapy; and medications, including immunosuppressive or anti-rejection drugs, which may cost up to $2,500 per month. The average cost of transplantation in 2005 ranged from $210,000 for a single kidney to over $800,000 for multi-organ transplants such as liver-pancreas-intestine.
Planning for transplant surgery requires financial planning. Health insurance may cover some or most of these costs, but insurance policies vary widely. You should call your insurance company or your employer’s benefits office to get detailed information about how your insurance company handles the costs related to your specific situation.
In general, you are responsible for any costs not covered by insurance. You need to think about what resources you will use to pay the costs not covered by insurance. These resources may include savings, sale of property, or other sources. Fortunately, you do not need to face these decisions alone. Members of the transplant team, such as the transplant center’s social worker and financial coordinator (discussed below), can help you develop a financial plan and may be able to put you in touch with organizations that give financial assistance to transplant recipients.
Medicare and Medicaid Services in Transplantation
Medicare is a Federal program, and Medicaid is operated by individual states. Both are health insurance programs that can help eligible people pay for the costs of transplantation and dialysis. Medicare is available for people age 65 or older, people who have certain disabilities, or people who have end-stage renal disease (ESRD).
Medicaid is an insurance program for low-income persons and is funded jointly by the Federal Government and the states. Each state determines who is eligible and what benefits and services are covered. Some state Medicaid plans cover only transplant procedures performed within that state (unless there is no transplant center for that organ in the state). Some states’ Medicaid programs do not cover transplantation. For more information on Medicaid, contact your financial coordinator, local Social Security office, the Social Security information line at 800-772-1213, or the financial coordinator at your transplant center.
Know Your Financial Coordinator
The financial coordinator at the transplant center is a member of the transplant team. Financial coordinators have detailed information and experience with health care financing and hospital billing. It is helpful to speak with the financial coordinator before making financial decisions related to your transplant and to keep the coordinator up to date as your financial plans evolve. The financial coordinator can help you:
- Understand how your insurance company’s benefits apply to transplant surgery;
- Make a financial plan for paying for your transplant;
- Make a financial plan for nonmedical (for example, living expenses) costs;
- Locate additional sources of funding, if necessary; and
- Understand (and, if necessary, correct) bills from hospitals, doctors, pharmacies, and other providers.