Going through the transplantation process requires detailed financial planning. Knowing ahead of time what to expect is an essential part of the process. The majority of insurance companies require prior notification for all transplant services. Some of the charges to expect include the evaluation process, surgery, hospital stay, follow-up care and medications.
Contacting your insurance company ahead of time is one of the most important things you can do in preparation for your child’s transplant. The insurance company will help you understand your individual coverage and benefits based around the transplant. You will be responsible for all co-pays and deductibles after charges have been processed. Assistance is available for families who cannot afford these excess costs.
The Pediatric Transplant Center's dedicated financial coordinator will work with your insurance company to obtain prior authorization for transplantation and will appeal any denials if turned down for the procedure.
Our financial coordinator can also assist you in identifying additional financial resources needed during the process. Assistance is available if you have no insurance or limited benefits for transplantation. The coordinator will also assist you with out-of-pocket expenses, denied services or general financial questions.
Call our financial coordinator at 617-355-0137 before your evaluation if you:
- Have any questions regarding your insurance
- Do not have insurance
- Do not have benefits for transplantation
- Are denied coverage for a transplant
- Anticipate that your insurance will be changing during the process
Medicare & Medicaid
Patients undergoing kidney transplantation are automatically eligible for Medicare coverage. For patients who already have private insurance, Medicare becomes primary coverage 30 months post-transplant. Applying for Medicare when this time draws near can help alleviate future financial strain and add assistance.
- Part A (hospital coverage): This covers the inpatient admission costs.
- Part B (outpatient care): This covers 80 percent of charges that include outpatient clinic visits.
Medicaid is another option for families with limited resources. Though Medicaid coverage is based on family household income, it is still an option for some families over the income guidelines when transplant coverage is concerned. It will be essential to contact your local welfare office to see what type of Medicaid category you may fall under.
Social security income (SSI)
SSI, if you're eligible, can pick up out-of-pocket costs after Medicare payment; we can assist you in the application process and determining your eligibility. The Social Security information line can be reached at 1-800-772-1213 or online at www.socialsecurity.gov.
There are many local and national organizations dedicated to providing information, support and financial assistance to transplant recipients. We encourage you to utilize these resources throughout the transplant process. Please feel free to contact your program’s social worker in the Pediatric Transplant Center directly if you have questions related to these resources.
Note: This list is not an endorsement of services.
- Novartis (Cellcept, Myfortic & Neoral)................... 1-800-277-2254
- Astellas Program (Prograf).................................... 1-800-477-6472
- Abbott Patient Assist (Gengraf)............................. 1-800-222-6885
- Amgen (Aranesp, Epogen).................................... 1-800-675-8416
- RapAssist Patient Assistance (Rapamune)...... 1-877-472-7268 or 1-800-378-7645