FINANCIAL INFORMATION :
Overview
When considering transplant, it is important to contact your insurance provider for a detailed explanation of your transplant benefits. Some insurers participate with “transplant networks” that require you to receive your care at designated facilities. Other important policy restrictions may also apply. Ask your insurer’s member service department if they will assign a nurse case manager to assist you in planning your care.
Contact Information
Transplant Financial Coordinator
Ellen MacLaughlin
emaclaughlin@partners.org
phone: (617) 724-0009
fax: (617) 726-7464
Massachusetts General Hospital
55 Fruit Street GRB 140
Boston, MA 02114
Links to Financial Resources
Listed below are some programs and organizations that can help with insurance coverage or financial assistance.
Medicare coverage is available to patients who receive a kidney transplant or who are on dialysis for End Stage Renal Disease (ESRD). Your social worker or financial coordinator can help explain these benefits and assist with applications. For other transplants, patients may already qualify for Medicare based on disability, but a transplant is not in and of itself a qualifying event.
This is geared toward providers but has a pretty clear description of the benefits and eligibility requirements for Medicare for ESRD.
This is for assistance with prescription drug coverage questions.
Medicare: 1 800 MEDICARE (1 800 633-4227)
Social Security Administration: 1 800 772-1213
Medicaid (called “MassHealth” in Massachusetts) is a state
program that can provide insurance coverage. Eligibility is based on income and disability. If you qualify for Social Security disability or consider yourself disabled, you may qualify for assistance. Medicaid can also help with premium payments on your current insurance policies in some situations.
MassHealth customer service: 800 841-2900
MassHealth Enrollment Centers (MECs):
Springfield MEC
333 Bridge St
Springfield, MA 01103
800 332-5545
Revere MEC
300 Ocean Ave
Revere, MA 02151
800 322-1448
Taunton MEC
21-A Spring St
Taunton, MA 02780
800 242-1340
Tewksbury MEC
367 East St
Tewksbury, MA 01876
800 408-1253
Transplant Costs
The financial costs of transplantation are significant. Not just for the surgery and the hospital stay, but also for evaluation and follow-up care and the expensive medications required post transplant. Other financial considerations are travel and lodging costs around the time of transplant as well as lost wages if unable to work for a period of time.
Average Transplant Costs
Below are estimated charges associated with transplant. Actual charges can vary greatly from case to case. Please keep in mind that the only medication costs listed here are one year of immunosuppressants, which you may need to continue taking indefinitely. You will most likely require several other expensive medications as well. Your insurer should cover the majority of these charges but you should have a general idea of what may be billed to your insurance.
*From the UNOS publication “What Every Patient Needs To Know”, 2002
Pharmacy Assistance Programs
Often the pharmaceutical companies themselves offer assistance programs for certain medications. Generally, eligibility for these programs is contingent upon meeting income guidelines and not having access to other insurance coverage. Here are some links to extremely useful websites that can help find programs to meet your specific prescription needs.
Commonly prescribed medication post transplant:
Fund Raising Organizations
There are several fund raising organizations that cater specifically to the transplant community. They can help work with you and your community to raise funds to assist with medical costs. Even if you have insurance it is worth looking into these programs, as you are still likely to have some out of pocket expenses.
National Transplant Assistance Fund
800 642-8399
Children's Organ Transplant Association
800 366-2682
National Foundation for Transplants
800 489-3863
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