Insurance and Financial Issues

A transplant is expensive. Learn how to plan for expenses and work with your health insurance provider.

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A bone marrow, stem cell or cord blood transplant is an expensive medical procedure. The cost will depend on:

  • the transplant center you choose
  • the type of transplant you will have
  • the length of your hospital stay
  • complications that may arise

It's important to plan, in advance, how your medical and routine expenses will be covered while you undergo treatment.

Will Insurance Cover my Transplant?

Prior to your transplant, your transplant center will contact your health insurance provider to request pre-approval for your transplant.

Whether the cost will be covered depends on the specific language in your insurance contract.

If your insurance provider denies coverage for your transplant, you can appeal that decision.

  • The specific steps for filing an appeal are spelled out in your insurance contract and must be followed exactly.
  • The financial coordinator at the transplant center may file the appeal on your behalf.
  • If you are filing the appeal on your own, be sure to enlist the help of an attorney familiar with this area of law.

Common reasons for denying coverage are that the insurance provider considers the procedure experimental or not medically necessary. Often, additional information from the transplant center will resolve the issue. 

Many insurance companies require their members to choose from a list of pre-approved transplant centers, which may not include the one you have chosen.

  • Usually these are transplant centers that provide excellent care.
  • Unless you can demonstrate that the center you chose offers superior service, it is unlikely you will be approved for a transplant at that center, even if the center is closer to your home.

Paying for Out-of-Pocket Expenses

Although your insurance provider may pre-approve payment for the actual transplant, some procedures, such as donor search and testing costs, may not be covered. If you will be transplanted with cells from an unrelated donor, you may be eligible for donor search assistance funds from Be The Match.

You may also have deductibles and co-pays that add to your out-of-pocket expenses. Prescription drugs, wigs and medical devices may or may not be covered by your plan.

Ask the financial coordinator at your transplant center to help you estimate your out-of-pocket expenses for medical treatment. If you have been assigned a case manager by your insurance company, he or she can help you estimate out-of-pocket expenses as well.

If you are traveling away from home for your transplant, you will have other expenses such as lodging, food and transportation to consider. Check BMT InfoNet's Resource Directory for organizations that may help you with some of these expenses.

If You Have No Insurance

If you have no insurance, you may be eligible for a government sponsored insurance plan. Healthcare.gov is a web site designed to help you find insurance options.

The U.S. National Institutes of Health offers free transplants to those who qualify for one of their research protocols. To learn whether you qualify, contact the two branches who offer this service:

Organize Your Household Expenses

You'll want to plan for how your financial obligations will be managed in your absence:

  • Who will pay your monthly bills?
  • Can you set up automated payments?
  • Who will manage health insurance issues?
  • Who will pay your taxes?
  • Do you need to make special arrangements with your bank so that the person paying your bills has access to your funds?

If you will be unable to pay routine bills such as rent, mortgage or utilities during treatment, talk with your creditor about arranging for a deferred or reduced payment plan until you are well.

It is better to set up a plan in advance, than wait until you fall behind on your bills.

Sometimes family members and friends will hold fundraisers to help you with your expenses. Several organizations such as HelpHopeLive, the National Foundation for Transplants, and the Children's Organ Transplant Association can help your loved ones organize these events.

In addition to the groups that provide financial assistance listed BMT InfoNet Resource Directory, your transplant center may have access to funds from local sources to help patients with transplant-related expenses, as well.

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