Transplant financial coordinators have a wealth of information about how to help pay for your transplant procedure. They have worked with people from all walks of life as they have crossed the bridge to transplantation. Our financial coordinators are essential in helping make the transplant a reality and can cut through complicated financial issues with you.
Coordinating financial matters requires the help of an expert. At Virginia Mason Franciscan Health, the transplant financial coordinator provides that expertise. After the transplant referral is received, the transplant financial coordinator reviews your medical insurance coverage. He or she will then determine if you are eligible for transplantation at Virginia Mason. Virginia Mason Franciscan Health works with most insurance plans; however, there are policies that require the patient to receive the transplantation elsewhere.
Once it is determined your insurance allows coverage at Virginia Mason Franciscan Health, the financial coordinator provides you with a benefit summary. The summary contains information about what your plan covers and an estimate of out-of-pocket expenses.
The financial coordinator will meet with you one-on-one on evaluation day. This is an opportunity to review your insurance needs and answer any questions. During the course of this discussion, you may hear about other coverage options. We have listed some of the options commonly discussed.
Medicare is a federally funded health insurance program of the Social Security Administration. You are eligible for Medicare at the start of treatment, either dialysis or transplant, if you have paid into Social Security. You may qualify under a spouse's benefit.
Please note: Medicare parts A and B do not pay 100 percent of the transplant surgery. There are hospital and professional fee deductibles. Physician fees and immuno-suppressive prescriptions are covered at 80 percent.
Employer Group Health Insurance is provided to you or your spouse's employer. Benefits such as deductibles, co-payments and out-of-pocket limits vary. There may be a pre-existing condition clause, transplant waiting periods or restrictions as to which transplant center is covered. A benefit booklet can usually be obtained from an employer's Human Resource Department.
Individual coverage is offered in some states. This type of coverage requires regular payments or "premiums". Contact your State Insurance Commissioner's Office to find out which individual plans are available in your state. Washington, Alaska and Montana each offer a state-sponsored High Risk Pool Insurance to individuals regardless of their medical condition.
Medicaid is a federal and state health program based on an individual's income, assets and medical necessity.
KDP is a state-funded program administrated through your dialysis center. Eligibility is based on income and assets. Indian Health Services (IHS) If you are an actively registered member of a federally recognized tribe, medical benefits may be available. Contact the Contract Health Division office at the local IHS clinic or hospital.
You might want to consider doing some fundraising for out-of-pocket expenses not covered by insurance. Two organizations that we recommend to assist you with this are:
National Transplant Assistance Fund
National Foundation for Transplant
There are many other resources that you might want to consider. Please do not hesitate to discuss your unique needs with your transplant social worker.