FAQ: Financial Issues

Please do not hesitate to ask your questions—however trivial they may seem to you. Every step of the way, your Transplant Coordinator will be available by telephone to answer any questions—and there is no such thing as a "silly" or "dumb" question. Please feel free to ask any questions, at any time, for any reason. We are here to help you.

Your Transplant Coordinator is available if you have any questions or concerns, and you may, of course, contact any member of the Kidney Transplant Team at any time with your questions.

The staff at the Kidney Transplant Center will answer all calls between 9 a.m. and 4 p.m., Monday through Friday, except holidays. The Transplant Coordinators will return these calls at their earliest convenience, usually the same day that you call. The Transplant Office number is 610-619-8420. Leave your name and telephone number where you can be reached. Try to be as specific as possible when you leave your message. Your call will be returned during the next business day. If you need to speak to a Transplant Coordinator during weekends, holidays or after hours, ask the answering service to page the Coordinator, who will return your call. If you have call block, please remember to remove it when expecting a call from our staff.

In an emergency: Call 911 immediately.

In the event of a life-threatening emergency, such as chest pain, coma, breathing problems, or bleeding, call 911 and they will take you to the nearest hospital emergency room. You and your family should always ask the physicians in the emergency department to call the Crozer-Keystone Kidney Transplant Center, but DO NOT try to drive to Crozer-Keystone in an emergency. Call 911.

What does a kidney transplant cost?

Kidney Transplantation is not inexpensive. For that reason, developing a financial strategy is something you cannot start soon enough. The costs associated with transplantation begin long before the actual surgery takes place and continue for the duration of your life after the operation. The costs can add up quickly, but there are many places to turn for aid. You should start working with your Financial Coordinator right away.

Costs can include:

  • Medical costs associated with your initial evaluation and testing; the actual surgery; your stay in the Intensive Care Unit after the operation; years of follow-up care, tests and medications.
  • Non-medical costs such as transportation for you and your family to and from the hospital before and after the transplant; food, lodging, and long distance phone calls for you and your family; child care; lost wages from work for you or a family member caring for you.

The Estimated U.S. Average Billed Charges per Transplantation during the first year following transplantation are approximately $143,000. The expenses continue for follow-up care and immunosuppressive medications, which can cost over $10,000 a year.

This might seem intimidating but you will have several people helping you put a plan together. The Social Worker on the Kidney Transplant Team will have information on government funding and disability programs. Your Financial Coordinator has detailed knowledge of all the financial options, including insurance. These professionals can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.

What are the costs if I have a living donor?

Generally, as the transplant recipient, your medical insurance (including Medicare) covers the cost of the donor's testing, surgery, and recovery in the hospital. At the same time, any medical treatment needed following the donation, such as annual physical exams, is your (or your donor’s) responsibility and may not be covered. The Financial Coordinator on the Kidney Transplant Team can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.

Is kidney transplant covered by insurance?

Many Insurance Companies have come to recognize organ transplantation as an acceptable medical treatment for end-stage organ disease and offer some level of coverage for transplants.

Insurance Companies will usually pay a portion of your hospital costs and you will be responsible for the remainder. For example, your policy may cover 80 percent of your hospital costs and you will be responsible for the other 20 percent. You will most likely have deductibles as well as co-payments for medications, doctor's office visits and other medical related expenses.

Most Insurance Companies have a lifetime maximum amount that they will payout to one recipient (often called a "cap"). Once that cap is reached, the insurance company does not have to pay any additional benefits. The amount of the cap varies and how you reach it varies. Sometimes it is based on one procedure and sometimes it is based on all combined procedures and treatments.

Many policies will require a pre-authorization or pre-certification before the transplant procedure. Some require referrals from your Primary Care Physician for each step in your transplant process starting with the tests done in the evaluation phase. Your Financial Coordinator will help you with all the required paperwork. You will want to keep up with your premium payments to ensure that your policy is not at risk of lapsing during this critical time.

Insurance policies vary widely so read yours very carefully to know exactly what portion of the costs will be your responsibility. You may want to talk to someone at your insurance company to answer your questions and help you clearly understand your coverage and options. And of course, keep your Financial Coordinator informed of any changes to your insurance status.

After the surgery, there will be ongoing costs of rehabilitation and medication, both of which may be at least partially covered by insurance. Outpatient pharmacy coverage, sometimes provided by insurance, will help with the cost of the medicines. The Pharma Patient Assistance Directory describes programs offered by pharmaceutical companies to patients who need financial assistance for prescription medications. To request this directory, call 1-800-762-4636.

If, after surgery, you find that you are unable to return to work due to your disability, you may qualify for rehabilitation reimbursement under your plan. There are also commercially available short- and long-term disability insurance coverage plans that may come into play, as well as several government programs that can help you finance your care after transplant.

The Financial Coordinator on the Kidney Transplant Team can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.

Does Medicare or Medicaid cover kidney transplant?

Medicare is a federal health insurance program available to people age 65 and older or disabled. It offers two basic plans, Part A and Part B. Part A is free and covers many hospital-related expenses like organ transplant surgery. You must pay a premium for Part B, which covers outpatient services including prescription drugs. Like most private insurance plans, Medicare does not pay 100 percent of your costs but you can purchase a private supplemental policy often referred to as “Medigap” to help pay for expenses not covered by Medicare.

Medicaid is a health insurance program run by a state federal partnership and is available to certain low-income patients without health insurance. Individual states decide who is eligible for Medicaid, determine what benefits and services to cover and set payment rates. You usually must reside in the state in which you are having your transplant in order to be covered.

The Financial Coordinator on the Kidney Transplant Team can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.

Does Crozer-Keystone accept all types of insurance?

Although many insurance companies offer coverage for transplant costs, the terms and benefits of insurance policies vary widely. Some insurance companies establish network agreements with certain transplant centers; the insurer may pay a higher proportion of costs for centers within their network. In addition, many transplant centers have different policies about the types of insurance they accept for the type of transplant you need.

What if my insurance does not pay for medications?

Many pharmaceutical companies provide medications for patients who are financially needy. For a full directory of programs, including who is eligible and what drugs are covered, visit the Pharmaceutical Research and Manufacturers of America website at www.pharma.org.

Questions To Ask

  • Am I eligible for prescription drug assistance? If so, for how long?
  • Do I need a referral from my transplant team to be eligible?
  • How long does it take to apply and process paperwork to get started with your program?
  • How do I receive the drugs?

What happens if my financial coverage runs out?

Many insurance policies state a total amount of money that will pay out in your lifetime, also referred to as a "cap." After the insurance company pays this amount, they are not required to pay additional benefits. Some policies also put a cap on how much they will pay for a particular procedure or treatment, such as a transplant or the total amount of drugs per year. Even after the actual transplant, the ongoing cost of care may exceed the cap. Because the amount of the cap varies greatly depending on the individual policy, it is important to be familiar with the terms of your insurance cap and keep track of how your insurance dollars are spent.

Alternatively, you can call your state insurance commissioner to see if the following plans are available in your state:

  • Certain people with pre-existing conditions, who have been denied insurance coverage, qualify for high-risk pools. High-risk pools are only offered in some states and premiums can be from 50% - 200% higher than standard policies. Benefits are usually more limited than standard policies and have limited coverage for outpatient medication.
  • Some states offer guarantee issue, which requires insurers to offer individual coverage regardless of pre-existing conditions. All individual policies are usually more costly in these states.
  • Federal fallback requires insurance companies to offer coverage to patients whose existing COBRA benefits are ending. It is only available in some states and provides patients a choice of the two most popular insurance plans that the insurance company offers. The premium is the same as everyone else within the policy.

Is there any charitable assistance available for kidney transplant patients?

Charitable organizations may be able to help in a variety of ways. Some may offer educational information about disease management and subsequent options. Some may provide financial assistance. Often these funds are for smaller amounts of money and usually limited to the direct costs associated with the transplant.

Some people are able to raise money for their transplant with a fundraiser. Keep in mind that funds raised this way are subject to certain rules and may conflict with some of your other income sources. Discuss this option thoroughly with your Financial Coordinator before you proceed.

The United Network for Organ Sharing (UNOS) has put together a list of many organizations that can provide financial assistance to transplant recipients. Visit www.unos.org and click on "Patient Resources" or call 1-888-894-6361.

The Social Worker and the Financial Coordinator on the Kidney Transplant Team will have information on many charitable assistance programs. These professionals can help answer many of your questions; but it is always recommended that you explore the details and limitations of available assistance directly with the charitable organizations.

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Crozer-Chester Medical Center

Crozer-Chester Medical Center

One Medical Center Boulevard
POB II, Suite 220
Upland, PA 19013