What Every Patient Needs to Know - UMC

Financing your TransplantThe first step in developing a financial strategy isto figure out how much of your costs insurancewill cover. Your financial coordinator or socialworker can help. Then you can begin to exploreother funding sources.Most patients use a combination of sources.Some patients can finance the transplantprocedure through their primary insurancecoverage and use savings and other private fundsto pay for other expenses. Many patients workwith community fundraising groups to completetheir transplant financial strategy.Common sources of transplant funding:• private insurance• Medicare coverage• Medicaid coverage• TRICARE (formerly Champus)• Veterans Administration• state “high-risk” insurance pool• prescription drug assistance programs• personal fundraising campaigns• charitable organizationsPrivate Health InsuranceEven if you have health insurance, the terms andextent of coverage vary widely. Read your insurancepolicy carefully to see what types of transplantcosts (lab tests, medications, and follow-upappointments) are covered. If you have questions,contact your employer’s human resourcesdepartment or contact your insurancecompany directly.• What are my co-payments for∞∞doctor visits?∞∞hospitalizations?∞∞medications?• Does my plan require prior authorization?• Who needs to get prior authorization?• Does my plan have a lifetime maximum or“cap” for transplant services?• Do any pre-existing-condition requirementsapply to coverage for a transplant?Regardless of how much your insurance covers,you are responsible for any unpaid costs,unless you have made other plans. Keep up withyour insurance premiums so that you do notlose your coverage. Include these costs in yourfinancial strategy.COBRA Extended Employer Group CoverageIf you are insured by an employer group healthplan and you must leave your job or reduce yourwork hours, you may qualify for extended coveragethrough COBRA (Consolidated Omnibus BudgetReconciliation Act of 1985). This federal lawrequires certain group health plans to extendcoverage for 18 to 36 months after benefitsend. This requirement is limited to companiesemploying 20 or more people. You pay thefull cost of the premiums for the group healthplan. Learn more by contacting your employer’sbenefits office or visit the federal Department ofLabor site at www.dol.gov (click on Health Plans& Benefits>COBRA).Some insurance questions to consider:• Is my transplant center in-network with myinsurance company?∞∞If my transplant center is out-ofnetwork,do I have an out-of-networkbenefit for transplant?• What deductibles will apply?31