Financing Your Transplant

Your doctor says you need a liver transplant. You go through all the emotions. You're frightened, hopeful and possibly confused. You wonder, "How long will I be on the waiting list? Will I get an organ in time?"

When dealing with concerns about your medical condition, the last thing you want to worry about is how much your transplant will cost. We have a knowledgeable team of people here at Lahey, including a social worker and a financial coordinator, who will help you get the answers to your questions.

Although the information about financing your transplant and medications can be overwhelming, you, your financial coordinator and the social worker will work closely together to develop a plan that works best for you. Our dedicated financial coordinator will guide you through the entire process, including contacting your insurance company for benefits information and approval for your transplant.

If you have stopped working because of your illness, your financial coordinator can help you determine whether and how your former coverage can be extended. Some important points to consider, depending on whether or not you currently have health insurance to cover transplant-related costs are presented below.

If you have insurance coverage

Transplants are very expensive, so you should make sure there are no special riders on your policy or limitations. Prescription coverage is imperative, as the cost of transplant medicines is high. If you have an HMO or POS insurance plan, make sure you obtain all necessary referrals to avoid any billing issues.

If your health plan covers only partial costs, your social worker and/or financial coordinator can help you find ways to finance the out-of-pocket expenses. There are programs designed to assist transplant recipients with their unique financial needs.

If you do not have health insurance coverage

Not having health insurance poses a challenge for patients in need of transplant, but your financial coordinator can help you investigate a number of other options, such as state or federal funding and assistance through charitable organizations or advocacy groups.

Check with your local Medicaid office for eligibility, which is based primarily on income. In addition, most states have a High Risk Health Insurance Pool for individuals with preexisting conditions who need to purchase an insurance plan. Check with your state's insurance commissioner for more information.

On the Internet, you can logon to your state's Web site, where you will find links to government agencies for insurance or health care. You can also consult your local phone book for agency listings under the government section.

There are several agencies that will assist you in fund raising, and we can provide you with information on these resources. If you are out of work due to disability, you should apply for Social Security Disability Insurance. You will become eligible for Medicare coverage after receiving these Social Security benefits for two years. For more information, consult the Web sites for Medicare or the Centers for Medicare & Medicaid Services.