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    Financial Matters: Liver Transplant Costs

    When considering a liver transplant, the associated costs and how you can best handle them must also be considered. At California Pacific Medical Center, a financial coordinator meets with patients during their initial evaluation to review specific insurance coverage issues related to transplantation.

    The following material provides a general outline of liver transplant costs and financial options. Your financial coordinator will review this information in further detail at your liver transplant evaluation.

    Transplantation Costs

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

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

    Costs associated with liver transplantation include:

    • recovery and in-hospital stay
    • extensive lab tests
    • anesthesia
    • fees for transplant surgeons and operating room personnel
    • organ recovery
    • transportation to hospital (including air transport charges if necessary)
    • lodging, transportation and food for family members while the patient is hospitalized
    • physical therapy and rehabilitation
    • patient lodging following discharge (patients who live more than 50 miles away must stay near hospital for a minimum of 30 days following discharge)
    • anti-rejection drugs and other medications (these costs can easily exceed $10,000 in the first year, and some of these medications are required for the rest of a transplant recipient's life).

    Estimated Liver Transplant Costs
    According to the United Network for Organ Sharing (UNOS)' Transplant Living Web siteOpens new window, the estimated U.S. average in 2011 of billed charges per liver transplant is $577,100.

    Additionally, liver transplant patients need to take several drugs called immunosuppresives to sustain your transplanted liver for the lifetime of your transplant. The following are estimates and depend on the dosage and pharmacy used. Note that most health plans pay a percentage of medication costs, as described in the next section.

    • Prograf: Total monthly cost is approximately $3,000
    • Cellcept: Total monthly cost is approximately $1,400 (required for approx. first three months only)
    • Septra: Total monthly cost is approximately $7.00
    • Prednisone: Total monthly cost is approximately $7.00
    • Proton Pump Inhibitor: Total monthly cost is approximately $30 (required for approx. first 3 months only)
    • Nystatin: Total monthly cost is approximately $40 (required for approx. first 2 months only)
    • Valcyte: Total monthly cost is approximately $3,000 (required for approx. first 3-6 months only)
    • HBIG 5cc vial: Cost is approximately $900 per injection (hepatitis B only)
    • Lamivudine or Baraclude: Total monthly cost is approximately $900 (hepatitis B only)

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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, you will meet with a financial coordinator to discuss financing options and possible sources for obtaining funds. Among the most common funding sources include: private insurance, Medicare and Medi-Cal, TriCare, Social Security Income (SSI) / Social Security Disability Income (SSDI), Fundraising Campaigns and Self-Pay.

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    Private Insurance

    Private insurance often pays for a large portion of liver 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.

    Some 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

    Because California Pacific Medical Center is a Medicare- and Medi-Cal-approved liver transplant program, 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. For California residents, Medi-Cal covers transplantation.

    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 Liver Disease (ESLD). There are two parts to Medicare: Part A (hospital insurance) and Part B (medical insurance). Medi-Cal is state-funded health insurance program for low-income individuals.

    The current Medicare deductible for hospitalizations in 2012 (Medicare Part A) is $1156, 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 liver transplant hospitalization. We require that an individual has secondary insurance to pay what is not covered by Medicare. Examples of secondary insurance include private insurance, Medicare supplemental insurance or Medi-Cal. .

    For more information on Medicaid/Medi-Cal, visit www.cms.govOpens new window or for California residents, www.medi-cal.ca.govOpens new window.

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    TriCare

    Government funding for families of active duty, retired or deceased military personnel may be available through TriCare. TriCare shares the cost of liver transplants for patients with end-stage liver disease. Patients must receive pre-authorization from TriCare and meet program criteria.

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

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

    These benefits are available from the Social Security AdministrationOpens new window. 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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    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. Your financial coordinator will discuss fundraising options with you in more detail.
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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). The financial coordinator will review estimated rates for evaluation and transplantation by phone.
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    Financial Assistance Resources

    The following organizations may provide financial assistance to qualified transplant candidates or recipients and their families.


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