Does insurance cover it?


We've kind of covered this in the two previous sections titled "What does it cost?" (referring to the transplant), and "What do they cost?" (referring to the medications).

However, the overall question of does insurance cover it is one that may be perplexing to the individual that cannot get a straight answer from their insurance company (which includes nearly all of us).  I usually leave such concerns up to the transplant facility, as they have to get paid, and if your insurance WON'T cover it, you'll generally hear about it well in advance of any real commitment they make to you.

There are some strange situations out there, however.  Some centers work amazingly well with certain HMO's, which is surprising to me.  However, there is always the danger that even if your center is covered by your HMO today, your HMO can pull out of the area served by your center by the time you are to be transplanted, leaving you high and dry.  So what is covered now may not be what is covered then.  This is not easily planned for, nor easily avoided, but a fact of life in today's medical insurance environment.  What it generally means is that you will have to move your accrued time to a transplant center that is covered by whatever insurance you are able to get, which may require a Medicare-approved facility where one was not required before, for example.  You need to stay flexible.

Another horror story that can happen is that complications can set in that cause expenses to exceed your annual and/or lifetime cap.  This is somewhat more visible--if you have a low cap, you should look into supplemental insurance, if it exists.

Above all, stress kills.  These issues are best handled by the patient's caregiver if at all possible.  I have a paranoid vision that insurance companies actually have a business plan that includes beating up older and/or sickly patients until they either just give up or die, whichever comes first.  Here as well as in the doctor's office, the patient needs an advocate that will ask the tough questions and kick ass if they get a run-around.  In no other business where a person's life is at risk are such inhumane tactics practiced as within the insurance industry, unless it is the Police or even worse, bad doctors.