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 transplantation costs and financial options. Your financial coordinator will review this information in further detail at your transplant evaluation.
- Transplantation Costs
- Financing Transplantation
- Private Insurance
- Medicare and Medi-Cal
- CHAMPUS
- Veteran's Administration (VA) Benefits
- Social Security Income (SSI) and Social Security Disability Income (SSDI)
- Charitable Organizations
- Fundraising Campaigns
- Self-Pay
- Financial Assistance Resources
Transplantation 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:
Estimated Liver Transplant Costs
According to the United Network for Organ Sharing (UNOS), estimated charges for liver transplantation are:
Estimated First-Year Charge: $314,600
Estimated Annual Follow-up Charge: $21,900
Following your transplant, you will need several drugs, called immunosuppresives, to sustain your transplanted liver. The immunosuppressive medications may include Neoral, 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, as described in the next section.
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 transplant coordinator 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, Fundraising Campaigns and Self-Pay.
Back to topPrivate 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.
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.
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. Hawaii's Medicaid program also covers this surgery but Nevada's Medicaid program does not.
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 the year 2007 (Medicare Part A) is $992, 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 $131 annual deductible has been met. The patient is responsible for the 20% of physician fees not covered by Medicare during a liver 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.
For more information on Medicaid/Medi-Cal, visit www.cms.gov or for California residents, www.medi-cal.ca.gov.
CHAMPUS
Government funding for families of active duty, retired or deceased military personnel may be available through the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). CHAMPUS shares the cost of liver transplants for patients with end-stage liver disease. Patients must receive pre-authorization from the CHAMPUS medical director and meet program criteria.
For more information, contact the health benefits advisor at your nearest military healthcare facility.
Veteran's Administration (VA) Benefits
If you are a veteran, the VA can help pay for treatment. Contact your local VA office for more information.
Back to topSocial 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.
Back to topCharitable 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.
Back to topFundraising 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.
Back to topSelf-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 and a discount will be given on the total bill at the time of discharge. For more information, contact Janelle Gray or Ana Chacon (spanish-speaking).
Back to topFinancial Assistance Resources
The following organizations may provide financial assistance to qualified transplant candidates or recipients and their families.
American Organ Transplant Association
(281) 261-2862
American Liver Foundation
(800) 465-4837
Medicare Hotline
1-800-633-4227
1-800-MEDICARE
National Transplant Assistance Fund
1-800-642-8399
National Foundation for Transplants, Inc.
1-800-489-3863
* This information was adapted from "Financing Transplantation: What Every Patient Needs to Know." United Network for Organ Sharing: UNOS. copyright 2002.