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    Costs and Financing of Kidney Transplant

    When considering a kidney or kidney/pancreas transplant, the associated costs and how you can best handle them must also be considered.

    Transplant costs and financial options are outlined below. You can also learn more about financing your kidney transplant on the transplantliving.org Web site. For further information, contact our financial coordinators, listed on our team directory.

    Kidney Transplant Costs

    The costs of your transplant include transplant evaluation and testing, transplant surgery and follow-up care and medication.

    Even before a transplant, you have probably received many medical bills for treatment by your physician, hospital, laboratories and medical specialists. These costs add up quickly.

    One of the biggest costs--and one that varies greatly according to a patient's condition--is time spent in the intensive care unit (ICU). Patients are generally taken to the ICU after the transplant operation and some patients are treated in the ICU before the transplant, depending on their condition.

    Other costs associated with transplantation include:

    • recovery and in-hospital stay
    • extensive lab tests
    • anesthesia
    • fees for transplant surgeons and operating room personnel
    • organ recovery
    • lodging and food for family members while the patient is hospitalized
    • physical therapy and rehabilitation
    • anti-rejection drugs and other medications (monthly estimated cost is about $3,000 immediately following transplant)

    According to the United Network for Organ Sharing (UNOS), the first-year billed charges for a kidney transplant are more than $262,000.

    Following your transplant, you will need several drugs, called immunosuppresives, to sustain your transplanted kidney and/or pancreas. The immunosuppressive or anti-rejection medications may include Cellcept, Prograf and Prednisone. The following are estimates and depend on the dosage and pharmacy used. Note that most health plans pay a percentage of medication costs.

    • Cellcept: Total monthly cost is approximately $1064
    • Prograf: Total monthly cost is approximately $1,340
    • Prednisone: Total monthly cost is approximately $12
    • Myfortic: Total monthly cost is approximately $806

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    Financing Transplantation

    Few patients are able to pay all of the transplantation costs from a single source. For example, you may be able to finance the transplant procedure through insurance coverage and pay for other expenses by drawing on savings accounts and other private funds or by selling some of your assets. Most likely, you will have to rely on a combination of funding sources. During your evaluation at California Pacific Medical Center, you will meet with a social worker to discuss financing options and possible sources for obtaining funds. Among the most common funding sources include: private insurance, Medicare and Medi-Cal, CHAMPUS, Veterans Administration Benefits, Social Security Income (SSI)/Social Security Disability Income (SSDI), charitable organizations and fundraising campaigns.

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    Private Insurance

    Private insurance often pays for a large portion of kidney and kidney/pancreas transplant costs, however, the terms and extent of coverage vary depending on insurers. Read your policy carefully, including the evidence of coverage (EOC) and contact your insurance provider if you have questions. When speaking with your insurance provider, ask if they will pay for organ recovery charges associated with the operation and medications after transplant. Usually, insurance companies will pay about 80% of your hospital charges. This means you must cover the remaining 20% from other sources.

    Most insurance policies have some sort of lifetime maximum amount, or "cap." After a patient has reached this amount, the insurance company does not have to pay any additional benefits. The amount of cap varies, depending on the individual policy. Sometimes after the transplant, the ongoing cost of care may exceed the cap, so it is important to be familiar with the amount and terms of your insurance cap.

    If you have any doubt about how your coverage is determined, contact your insurance company. If you still have questions, contact your State Insurance Commissioner.

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    Medicare and Medi-Cal

    State and/or federal government funding is another possibility for coverage under two programs: Medicare, operated by the federal government; and Medi-Cal, administered by the state with federal assistance.

    Medicare is a federally-funded health insurance program available to retirees over age 65, disabled people and other qualifying individuals, such as those with End-Stage Renal Disease (ESRD). There are two parts to Medicare: Part A (hospital insurance) and Part B (medical insurance). Medi-Cal is a state-funded health insurance program for low-income individuals.

    The current Medicare deductible for hospitalizations in the year 2012(Medicare Part A) is $1,156, meaning the patient is responsible for this payment. If a patient is hospitalized several times through the year, this deductible must be paid each time, unless the patient is re-hospitalized within 60 days from a previous hospital discharge.

    Physician services, or Medicare Part B, are covered at 80% once a $140 annual deductible has been met. The patient is responsible for the 20% of physician fees not covered by Medicare during a kidney or kidney/pancreas transplant hospitalization. These fees are approximately $4,000. Medicare usually reimburses poorly on the anesthesiologist's bill and there is often a patient responsibility of $400-$500.

    Medicare Part D covers prescription medications, excluding the the anti-rejection drugs covered by other parts of Medicare.

    For more information on Medicare, see www.medicare.gov. For Medi-Cal information, visit www.medi-cal.ca.gov.

    Medicare Hotline
    1-800-633-4227
    1-800-MEDICARE


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    TRICARE (formerly CHAMPUS)

    Government funding for families of active duty, retired or deceased military personnel may be available through TRICARE (formerly CHAMPUS). TRICARE shares the cost of kidney and kidney/pancreas transplants for patients with end-stage organ disease. Patients must receive pre-authorization from the TRICARE medical director and meet program criteria.

    For more information, contact the health benefits advisor at your nearest military healthcare facility.

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    Veteran's Administration (VA)

    If you are a veteran, the VA can help pay for treatment and will cover anti-rejection medications for qualified recipients. Contact your local VA office for more information.

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    Social Security Income (SSI) and Social Security Disability Income (SSDI)

    These benefits are available from the Social Security Administration. They assist you with the costs of daily living. To find out if you qualify, talk to your social worker or call your local Social Security office.

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    Charitable Organizations

    Charitable organizations offer different types of support, ranging from disease and transplant information to limited financial assistance through grants and direct funding. Usually, you must apply for the funding. However, it is very unlikely that one group can cover all of the costs for an individual patient. If you are interested in pursuing funds from a charitable organization, a social worker at California Pacific can provide counseling on your options and how to apply.

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    Fundraising Campaigns

    Patients and families often use public fund raising to help cover expenses not paid by medical insurance, such as child care, transportation, food and lodging. This may, in fact, be a key source for financing transplantation. Proceed with caution and plan carefully before you begin, because there are many legal and financial issues to consider. For example, if you and your family have been accepted for Medicaid benefits and funds are raised for you, the donated money could be counted as income, and you may then lose your eligibility.

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    Self-Pay

    Occasionally, patients may prefer to pay out-of-pocket for all transplantation costs. This is particularly true for patients from overseas without health insurance (who are permitted by United Network for Organ Sharing (UNOS) regulations to account for a small fraction of a transplant program's patients). For self-pay patients, a transplant evaluation at California Pacific Medical Center is first required, then our financial coordinator can review estimated rates for the transplant. For more information, contact Isabel Zamora, financial coordinator.

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    Financial Assistance Resources

    The following organizations may provide financial assistance to qualified transplant candidates or recipients and their families. Please be aware that after transplant surgery, assistance from these organizations is limited. Instead, pharmaceutical companies often have patient assistance programs that can help legal U.S. residents with limited means obtain prescription medications.

    American Kidney Fund
    1-800-638-8299

    American Organ Transplant Association
    (281) 261-2682

    National Transplant Assistance Fund
    1-800-642-8399

    National Foundation for Transplants, Inc.
    1-800-489-3863

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    About California Pacific Medical Center

    California Pacific Medical Center, part of the Sutter Health network, offers kidney, pancreas, liver and heart transplantation as part of our Barry S. Levin, MD Department of Transplant.

    Kidney & Pancreas Transplant Program
    California Pacific Medical Center
    2340 Clay Street
    San Francisco, CA 94115
    Tel. 415-600-1000

    Outreach locations available throughout Northern California and in Reno.
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