HepC-Liver Transplant Financial Issues

Financial Issues Few patients are able to pay all of the costs of transplantation from a single source. This section describes financial resources and some of the more common ways transplantation is funded.

Most likely, you will have to rely on a combination of funding sources. For example, you may be able to finance the transplant procedure through insurance coverage and pay for other expenses by drawing on savings accounts and other private funds or by selling some of your assets. It's a good idea to keep your transplant center social workers and financial coordinators informed of your progress in obtaining funds.

COSTS

Transplant costs include:

transplant evaluation and testing;
transplant surgery;
follow-up care, lab tests and medication

Even before the transplant, these costs add up quickly. One of the biggest expenses is related to time spent in the hospital's intensive care unit (ICU). The ICU is staffed by critical care nurses and is equipped to monitor and treat critically ill patients. Patients are generally taken to the ICU after the transplant operation, but some are also treated in the ICU before the transplant.

Other costs directly associated with transplantation include:

fees for transplant surgeons and operating room personnel;
anesthesia;
recovery and in-hospital stay; and
extensive lab tests.

In addition, other expenses incurred prior to or following the operation include:

charges for evaluating and accepting a patient for transplant;
recovery of the organ from the donor;
transportation to and from the transplant center -- not only for the transplant, but for patient evaluation and check-ups;
food and lodging for family members while the patient is hospitalized;
laboratory tests;
child care;
physical or occupational therapy and other rehabilitation; and the cost of anti-rejection drugs and other medications, which can easily exceed $10,000 per year. These drugs are required for the rest of the recipient's life.

If you are travelling any distance to receive your transplant, remember to consider the cost of food, lodging and transportation. The cost of food and lodging for your family while you are in the hospital can vary greatly from city to city. Some centers offer family lodging at reduced or no cost, while other centers do not. More than likely, these expenses will not be covered by insurance.

There may also be lost earnings if your employer does not pay for the time you or your spouse spend away from work.

Estimated Charges for Organ & Tissue Transplantation

Below is an ESTIMATE of the first-year and subsequent follow-up charges associated with a liver transplant. Your transplant could cost much less or much more, depending on how many of the services are included in your bill and the area in which your transplant takes place. (These estimates are based on 1996 Dollars and will be higher now).

1st Year Charge:

$314,500 (this is estimated at approx. $500,000 in 1998)

Annual Follow-up Charges:

$21,900

Financing

    Usually, insurance companies will pay about 80 percent of your hospital charges. This means that you are responsible for the remaining 20 percent from other sources until you reach your "out-of-pocket" limit. Be sure to pay your premiums so that your policy will not lapse.
    Most insurance policies have some sort of lifetime maximum amount, or "cap." After a patient has reached this amount, the insurance company does not have to pay any additional benefits. The amount of the cap varies greatly, depending on the individual policy. The cap may apply to just one procedure or treatment or to all combined procedures and treatments. Even after the actual transplant, the ongoing cost of care may exceed the cap, so it is important to be familiar with the amount and terms of your insurance cap and how your insurance dollars are spent.
    Some insurers consider certain transplant procedures "experimental" or "investigational" and do not cover these cases. If you have any doubts about how your coverage is determined, contact your insurance company. If you still have questions, contact the office of your State Insurance Commissioner. Many companies require prior authorization (approval) for organ transplant procedures. Make certain that you are not in a waiting period for coverage for conditions you may have had before joining the insurance plan. Delays in insurance payments can cause you unnecessary stress, so make arrangements with your insurance company prior to the transplant. Transplant center social workers and financial coordinators will help you with the information you need to complete this process.
    You may want to seek help from an advocacy or charitable organization or a legal advisor to negotiate with your insurer. For example, if the company does not wish to cover your transplant, you may be able to prove that it has covered similar procedures in the past, or that a transplant would be more cost-effective than your current care (especially in the case of dialysis). If you can, you may have a better chance of getting coverage for your particular case.
    If you are insured by a group health plan (medical, dental or vision) through your place of work and you must leave your job or have your work hours reduced, you and your family may qualify for extended coverage through COBRA.
   Government funding for families of active duty, retired or deceased personnel may be available through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). CHAMPUS shares the cost of heart, lung, heart-lung, liver, kidney and combined liver-kidney transplants for patients with end-stage organ disease. Patients must receive pre-authorization from the CHAMPUS medical director and meet CHAMPUS selection criteria. Pre-authorization is based on a narrative summary submitted by the attending transplant
    Veterans of the Armed Forces who first became ill while in service or who are indigent as defined by the Veterans Administration (VA) may be eligible to receive a transplant at a VA Medical Center. Some veterans may also receive medications funded by the VA. For further information, contact your local VA office or your nearest VA Medical Center.

Charitable organizations offer different types of support. Some provide information about diseases of certain organs or about a particular type of transplant and encourage research into these diseases and treatments.
Other groups provide limited financial assistance through grants and direct funding. However, it is very unlikely that one group can cover all of the costs for an individual patient. An organization may have limits on using available funds, and may only be able to help with direct transplant costs, food and lodging or medication costs.

Advocacy organizations advise transplant patients on financial matters. They should be abl to provide supporting information and background documentation to prove that they are legally recognized to help those in need.

Patients and families often use public fund raising to help cover expenses not paid by medical insurance. This may be a key source for financing transplantation.
Proceed with caution and plan carefully before you begin, as there are many legal and financial issues to consider. For example, if you and your family have been accepted for Medicaid benefits and funds are raised for you, the donated money could be counted as ncome, and you may then lose your eligibility.

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