A stem cell transplant is a very expensive medical procedure. Depending on the transplant center, the length of time you must be hospitalized, and complications that arise, the treatment can cost hundreds of thousands of dollars. It is therefore not surprising that insurance companies are cautious when reviewing requests to approve this treatment.
Most transplant centers are skilled at providing insurers with the documentation needed to authorize coverage of a blood stem cell transplant.
Your transplant center will require pre-authorization from your health insurance company to ensure that the transplant expenses will be covered. If you do not have health insurance, your center will likely require a significant deposit from you before beginning treatment.
Appealing a Denial of Insurance Coverage
If your insurance company denies coverage of your transplant, it’s important to understand what they are denying: the transplant itself, or the medical center where you plan to receive treatment.
Many insurance companies have a "network of excellence" - transplant programs that meet their standards, both medically and financially - and require all plan enrollees to be treated at one of these centers.
If the insurance denial is for the transplant, itself, or part of the medical treatment associated with the transplant, you may be able to file an appeal.
Sometimes the issue is as simple as a wrong diagnostic code being used. Other times insurance may question whether the treatment is “investigational” or “experimental” rather than the standard of care for your disease.
The medical team at your transplant center should be able to provide information to your insurer to address these concerns.
Appeals usually need to be filed within a particular time period to avoid losing further rights to appeal. Your transplant team may appeal the denial of coverage for you, or help you file the appeal yourself.
TriageCancer is a not-for-profit organization that can help you understand your legal rights and find a qualified attorney, if needed.
Cancer Policies and Health Insurance Cost-Sharing Ministries
Some patients have a cancer policy and expect the policy to cover the full cost of a transplant. Cancer policies are not intended to replace full insurance plans and do not provide sufficient benefits to cover the cost of a transplant. Rather, they help cover things like deductibles and co-pays on your main health insurance policy and lost income.
In most cases, cancer policies need to be purchased before you are diagnosed with cancer in order for you to qualify for a payout.
Some patients belong to a health insurance cost-sharing ministry. These arrangements are not considered insurance by most transplant centers. They are pooled funds organized by a religious organization or social group. People voluntarily pay into the fund and the dollars are used to pay for members’ medical expenses.
The drawback with these ministries is that you have no legal protection or guarantee that your medical bills will be paid. Consequently, most transplant centers do not consider them true health insurance and will require a significant deposit from you up-front before beginning treatment.
Insurance Coverage for Clinical Trials
Some patients enroll in a clinical trial that is testing a new drug or treatment during transplant. The cost of the investigational/experimental portions of care being provided through the study are usually covered by the clinical trial sponsor. The rest of the services associated with the clinical trial are considered standard-of-care and are billed to the patient and his or her insurance.
Medicare has a special coverage policy for clinical trials, and the Affordable Care Act (ACA) has a requirement for most commercial insurance plans to cover the standard-of-care services on clinical trials.
When insurance plans authorize standard-of-care services on a clinical trial, patients may owe the same type of deductibles or co-payments as they owe for treatments that are not part of a trial.
Watch a video for more information about transplant and insurance.
Financial and Fundraising Assistance
Several organizations provide financial aid or fundraising assistance for transplant patients.
BMTInfoNet offers qualified patients help with expenses such as transportation, food and lodging.
NMDP offers financial help for donor-related expenses.
Bone Marrow and Cancer Foundation offers financial assistance for a variety of expenses.
The Leukemia & Lymphoma Society provides financial assistance to patients transplanted for a blood disorder.
HelpHopeLive and National Foundation for Transplants help patients raise funds for transplant and manage payment of medical bills.
Children’s Organ Transplant Association provides a similar service for pediatric patients.
BMT InfoNet’s Resource Directory lists other organizations that provide financial help to certain types of patients.
Ask the social worker or financial counselor at your transplant center if there are any local funds that may provide you with assistance.
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Updated June 2024
