It’s an unfortunate fact: Transplants cost a lot of money. But you shouldn’t let the price of a transplant scare you. Patients who need a transplant almost always find a way to pay for it with health insurance. There are private insurance plans and government programs, such as Medicare and Medicaid. Our Transplant Financial Coordinator is here to help you. An expert on insurance issues, the Financial Coordinator can help you find a way to pay for the care you need. Our Transplant Social Worker can also help you sort through money issues and develop a plan that works for you.
This is just a brief overview of money and insurance issues that transplant patients face.
How Patients Pay for a Transplant
Most people pay for transplant with insurance.
There are two types:
Private
Government, such as Medicare and Medicaid
You may need two insurance plans:
A primary one that pays a big portion
A secondary one that pay most of the remaining costs
Step 1: Start with Primary Insurance
A primary insurer pays a big portion of your transplant costs. Primary insurance includes:
Medicare
Medicaid
Private insurance plans
A primary insurer is one that pays for most of the costs of a transplant. May primary insurers will pay about 80-90% of transplant costs, but every plan is different.
** Find out what your primary insurer will pay for you. If there is a large out of pocket expense you will want to find a secondary insurance.
Step 2: Find Secondary Insurance, if you need it.
Secondary insurance helps pay for extra costs. The Transplant Financial Counselor or the Transplant Social Worker can help you find a secondary insurer.
Secondary insurance plans pay for many of the costs that primary insurance plans don’t cover. For instance, secondary insurers will often pay for some of your deductibles and co-pays. They may also help cover the costs of drugs or medical transport.
There are many options available for secondary insurance such as:
- A supplemental or “Medigap” policy. Many private insurers offer supplemental plans to help cover the medical costs that are not paid for by Medicare. An insurance agent can help suggest some plans that might be good for you.
- Medicaid. You may be eligible depending on your state’s guidelines.
- Medicare. Even if you have private insurance, you should apply for Medicare as a secondary insurer. If you or your spouse have worked, you are entitled to Medicare benefits.
Step 3: Consider fundraising and other funding sources.
Be careful how you go about fundraising. Talk to an expert first.
The Transplant Financial Coordinator or Social Worker may be able to help you find other ways to pay for the transplant expenses that are not covered by health insurance. Even with good insurance, you may need to pay for various things, such as a portion of your medicines, insurance premiums, childcare, and other costs.
Some patients qualify for various medical assistance programs. For instance, if you are a veteran, you may be able to get your anti-rejection medicines through a local VA Hospital. Or you may be able to get Social Security Disability Income.
Another way to cover expenses is fundraising. For instance, your friends or church members might offer to throw a bake sale or charity auction and give you the profit to pay for your medical costs. We encourage you to fundraise.
Be very careful how you go about fundraising as there are a lot of legal and money issues to consider. For instance, you will need to set up special bank accounts or trust funds for tax purposes, and the wording of the fundraising materials must be very specific or you could get in trouble.
Always work with a professional fundraising organization that is familiar with all the legal and finance issues. The following non-profit groups can help with fundraising. They help transplant patients around the country raise money for medical expenses:
Common Questions Regarding Finances and Insurance
Q. Do I need to get any type of referral or authorization from my doctor or insurance company before I can start the transplant process?
A. If you are in an HMO or POS, you will need to get a referral from your primary care doctor to start the transplant process. You should ask your primary care doctor for a "blanket referral" that lasts three months to cover your transplant evaluation.
All patients need a prior authorization from their insurer. Usually, the Transplant Financial Coordinator will work with your insurance company to get this authorization.
Q. What if I run out of funds before I get a transplant?
A. We will try to help you find another way to pay for your transplant.
Q. My spouse changed jobs and I now have different insurance. What should I do?
A. It’s important that you let us know right away if there are any changes in your insurance. The Transplant Financial Coordinator can call your new insurance company to make sure your transplant will still be covered.
Q. I have Medicare ESRD because I have kidney failure. As I understand, Medicare ESRD will only pay for my anti-rejection medicines for three years after my transplant. How can I pay for these medicines after that?
A. This is a realistic concern and it needs to be addressed. We will work with you to help you find another way to pay for them after three years. If you are under the age of 65, we hope you will be able to return to work after your transplant. Then, you may be eligible to get insurance through your work to pay for your anti-rejection medicines.
If you are older or cannot return to work, you may qualify for Medicare because of age or disability. Medicare will continue to pay for your anti-rejection medicines for the life of the transplant. Another option is Medicaid. We will work with you to find what option is best for your situation.
What Can You Expect to Pay
A kidney transplant, including pre-exams and surgery, can cost over $150,000.00. After the transplant, you will need to take anti-rejection and other medicines, which can add an additional $1,000.00 -$3,000.00 a month. Most of these costs are covered by insurance, but there are some hidden costs that you will need to be aware of.
Hidden Costs:
- Insurance deductibles and co-pays for doctor visits and prescription drugs.
- Transportation to and from the hospital.
- Childcare for any children you have while you’re in the hospital or at clinic visits.
- Food for yourself and your family when coming to the hospital.
- Lodging for your family and yourself if you don’t live nearby.
- Lost wages from your job if you need to take time off for surgery and recovery.
The Transplant Financial Coordinator or Social Worker may be able to help offer suggestions or help you locate resources to cover some or all of these expenses.
Sanford Transplant Center Toll Free: 1-800-949-0670 or
Financial Coordinator: Dana Trujillo - 605 -328-9296
Social Worker: Rick Reuwsaat - 605-328-9294
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