The financial impact of needing organ transplantation can be the source of much anxiety and concern for patients and families. The staff at the RCH Transplant Center understand the importance of considering the financial aspects of organ transplantation. Because of this, we have included financial issues in our patient care services. In addition to the general information that our clinical staff can share with you, we have a specialized group of staff available to assist you in understanding and navigating this difficult but important part of your overall care.
Transplant Financial Coordinators are unique to organ transplant and provide education and counseling on all aspects of the transplant process from the financial perspective. They collaborate and communicate with the Insurance Companies, Medicare and Medicaid offices, and with the clinical and social services of the transplant team to provide a complete financial plan of care for each individual patient. They are a valuable resource for information regarding all financial aspects of organ transplant coverage. Every potential transplant patient will have an opportunity to meet with a Financial Coordinator as part of the routine evaluation process for organ transplant. They will remain an important member of your healthcare team throughout the transplant process, often working behind the scenes, but available to you on request at any time in the process.
The RCH Transplant Center has dedicated Social Workers who have experience and training in organ transplant. One of their many responsibilities is to assist you in understanding the financial impact of your care. In particular, they will assist you with exploring your options to assist with prescription coverage after your transplant.
Financial Coordinating Staff
Social Worker Staff
Melissa Rice LCSW
Frequently Asked Questions
The majority of insurance carriers, including Medicare and Medicaid, pay for organ transplant. If you have Medicare as your primary coverage, your transplant must be at a Medicare approved center. Riverside Community Hospital is a Medicare approved center for organ transplant.
Organ transplant is a very costly procedure. Most patients cannot afford a transplant without some type of health insurance coverage. The costs can be divided into two categories; medical costs and non-medical costs. It is important to look at both sets of costs in preparation for a transplant.
Medical costs include but are not limited to:
- Insurance deductible
- Insurance co-pay
- Prescription drugs and non prescription drugs
- Evaluation and testing before transplant
- Transplant surgery
- Donor organ fees
- Care after the transplant
- Outpatient/clinic visits
- Laboratory testing
- Re-admissions to the hospital
- Physician fees including the transplant surgeon fee, anesthesiology fee, pathologist fee and radiologist fee
The items in italics (deductible, co-pay and prescription and non-prescription drugs) tend to account for the majority of the patient's out of pocket costs. In addition to these out of pocket costs, the patient will also have non-medical expenses to consider.
Non medical costs may include but are not limited to:
- Transportation to and from the transplant center before and after the transplant
- Food, lodging, and phone calls for you and your family
- Lost wages
- Child care
Also consider, if you live a long distance from the hospital, plane travel to the hospital for your surgery and lodging for a period of time close to the hospital before you return home after your transplant be needed.
In most cases, your insurance will not cover all of your expenses related to the evaluation, actual transplant surgery, hospital care, physicians' bills, post-transplant care and prescriptions. It is especially important for you to meet with a Financial Coordinator who is specially trained to understand the very complicated health insurance policies, Medicare and Medicaid. Based on a very thorough review of your coverage, the Financial Coordinator will be able to give you an idea of your out of pocket expenses related to the transplant.
This is one of the most important questions you need to answer before you proceed with a transplant. We need to make sure that you do have prescription drug coverage before going ahead with a transplant. If you cannot get your prescription drugs after your transplant, your transplant will most likely fail. Just because you have health insurance does not necessarily mean you have coverage for prescription drugs. Even if you have a prescription plan, it may not cover your drugs 100%—most do not. This means you may have out of pocket expenses for your prescription drugs for life. This amount can be over $500 per month for the first few months and continue from $200 – $500 per month long term.
Remember Medicare has significant limitations on coverage for drugs based on which plan you, the patient, enroll in. It is therefore extremely important that we help you explore what your prescription drug coverage is. If it is not enough to cover all of the medicines you will need, we will talk with you about the options available to get better coverage. Some very low-income patients may be eligible for assistance from many of the manufacturers of drugs. Patients with no insurance coverage for drugs may also be able to get help with their prescriptions. The Financial Coordinator and Social Worker will speak with you in more detail about these options when they meet with you.
You must pay this amount before your insurance coverage begins. You usually have to pay this amount every year.
The co-pay is the amount you will pay for each service you receive that is covered by your insurance plan. For example, each time you visit the doctor for a check-up, your insurance may pay $80 for the visit and you may have to pay $20.
Lifetime maximum is the amount of health care expenses that your policy will cover in your lifetime. This can be a very important point when you are considering costly procedures such as a transplant.
Definitely not! Unfortunately, they vary quite a lot. Items such as the deductible, co-pay, and lifetime maximum will all vary from patient to patient. It can be very hard for a patient to understand all of the points in their plan.
You can, and in many cases, you may be required to if your employer changes insurance carriers for instance. However, before you change, you MUST speak with your Financial Coordinator. This is important. The transplant center must get approval from your insurance plan BEFORE the transplant. We do this before we place you on the waiting list.
If you change insurance plans and do not tell us, we will not be able to get the proper approval. If you receive an organ transplant without approval from your insurance plan, they can deny payment for the transplant and all your after care.
The cost of a transplant can be overwhelming for a patient, so it is our goal to minimize your concerns about financial matters as much as possible. We do this by gathering information from you, the patient, answering your questions and providing assistance regarding insurance and the coverage you will need to offset your financial responsibility. The transplant center has a specially trained Transplant Financial Coordinator available to assist you in a compassionate and caring way regarding transplant financial matters.
Prior to your first visit with us, a coordinator will contact your insurance company to verify benefits and to get approval for your first visit to RCH Transplant Center. This is the beginning of the process of finding out if your coverage is going to be suitable. This also begins the process of getting approval for your transplant if that is the treatment that you will need. During your initial visit for transplant evaluation, one of our Financial Coordinators will meet with you. They will verify that the insurance information we have documented is current and correct and they will ask you questions to obtain all the following information:
- Detailed financial information on your income and expenses so we can assist you in estimating your ability to cope with the additional expenses that are part of the transplant process
- Review your responsibility for your insurance deductible and co-pay
- Discuss the benefits of supplemental insurance coverage, particularly in regards to the high cost of prescription medications
- Answer any questions or concerns you may have regarding your financial responsibility
- Provide information about additional resources and fund raising opportunities
The Financial Coordinator will need to get a complete 'picture' of your financial circumstances. They will then be able to discuss how organ transplant will affect you financially. They will ask you some detailed questions.
- Your average annual income
- Other sources of income
- Your average monthly expenses
- Number of household dependents
- Type of Insurance
- Prescription plan
- Employment or reason for disability
This is just some of the information that will allow us to do a complete assessment of how organ transplant may affect your financial situation. The Financial Coordinator will then be able to tell you if you need additional coverage and make recommendations to you about possible options to improve your coverage.