Transplant financial requirements

[Angiepkd]

I recently met a woman whose husband has been on D since 2011. She said they were rejected for transplant for several reasons including dental work needed and minimal weight loss. These things she felt were doable, even with their meager income (his disability SSI and her minimum wage job). What she told me next, caught me off guard. She said they were requiring proof of a savings account with a $40k balance.  Can this possibly be correct?  I certainly didn't have anywhere near that amount when I received my transplant.  Has anyone heard of something like this?  I am hoping she has misunderstood what the center told her.  These are very nice, hardworking people who do the best they can with what they have. I would like to be able to help them through the listing process, but never experienced anything like this. Thanks in advance for the help!

[sahern]

It has been a little over a year since I listed at both the Mayo Clinic in MN and Virginia Mason in Seattle WA (I live in Alaska). They did not say anything about money at the time and the only thing that they did check was my insurance.  My wife and I were both employed at the time.  Only my wife works at the moment, As soon as I get used to dialysis I will go back.  I would have them double check with the transplant clinic to make sure what they heard was correct. 

[Rerun]

They need to call the National Organ Procurement Agency and turn that transplant center in.  That is way off base... unless maybe they didn't have any insurance??  The anti-rejection drugs are expensive but usually insurance covers most of it.   

[cattlekid]

I've heard of that before from other transplant candidates as well. Personally, all my centers did was check my insurance and that was it.

[Angiepkd]

I am not sure what their private insurance situation is, but am assuming that he has Medicare because of being on dialysis since 2011.  I did some research and Medicare only covers 80% of the transplant costs. I had coverage from my husband's private insurance as primary and Medicare was secondary. I do remember having to get my transplant reviewed and approved by my private insurance prior to transplant. These are not wealthy people, and coming up with the 20% would be hard for them. So sad since he is only 49 and has always worked prior to the kidney failure. Hoping there is more to the story than what she told me. Thanks for the replies. I tend to forget how lucky I am to have a spouse with a good job and insurance.

[SutureSelf]

I recently met a woman whose husband has been on D since 2011. She said they were rejected for transplant for several reasons including dental work needed and minimal weight loss. These things she felt were doable, even with their meager income (his disability SSI and her minimum wage job). What she told me next, caught me off guard. She said they were requiring proof of a savings account with a $40k balance.  Can this possibly be correct?  I certainly didn't have anywhere near that amount when I received my transplant.  Has anyone heard of something like this?  I am hoping she has misunderstood what the center told her.  These are very nice, hardworking people who do the best they can with what they have. I would like to be able to help them through the listing process, but never experienced anything like this. Thanks in advance for the help!

Some transplant programs require patients who only have medicare coverage to raise $10k-20k which will be set aside in a special savings account.  The money will only be used to cover the costs of anti-rejection/immuno meds needed down the road.  Medicare only pays 80% for 3 years post transplant then stops unless the recipient is still deemed disabled for some other reason.

Rightly or not, some transplant programs are doing everything they can to make sure nothing is in the way of compliance to taking meds post transplant.  To them. that should not be an excuse for losing a scarce resource like a kidney.

I live in Georgia and the Georgia Transplant Foundation has a program that will match whatever someone raises up to $10K.  There are some rules, like the savings account must be kept by the Transplant Foundation and what the funds can be used for etc., but an extra $10K is great .  The down side - going out and having to fund raise for your self or having others do it for you.   Maybe there's such a resource in your state.

[justagirl2325]

It's the same here.  As a Canadian, 100% of medical costs are covered and I have good health care coverage at work for 100% of prescription drugs but we were still told to have $10,000 saved in anticipation of uncovered expenses (travel, rent, food).  We don't have that kind of surgery near us so we'd have to travel 1,000 to Toronto and he'd have to stay in the area for 8-10 weeks post op.  I'm not sure they'd deny him the transplant if he didn't have it though.

[Simon Dog]

I did some research and Medicare only covers 80% of the transplant costs.

True, however, another benefit is that the transplant center must accept the Medicare rate which can be a fraction of the private pay rate.

My private insurance was paying about $450 per treatment to the local center under contract, and paid a DaVita clinic $5050 each for two travel treatments.  (no, that is not a typo).  Now that I am on Medicare the treatments are a bit under $250 each.

[kickingandscreaming]

Does anyone know if Medicare Advantage insurance pays the full amount.  It differs from standard Medicare (usually) in picking up the rest of the tab except for copays.

[hatedialysis2]

I have medicare  supplementary plan thru AARP  that covers the 20% difference. Not sure about medicare advantage.

[smartcookie]

The hospitals that do transplants for my patients require between $10,000 and $20,000 for medication costs after surgery. The logic is that anti rejection drugs are expensive and you lose Medicare 36 months after transplant due to not being disabled anymore (unless you are 65 or older, or have another disability making you eligible for Medicare). This savings gives patients a safety net to pay for medications. I encourage patients to do fundraising and set them up with local organizations and websites like gofundme.com.

[kickingandscreaming]

websites like gofundme.com.

Another one is https://www.youcaring.com/  which is free.

[Simon Dog]

Does anyone know if Medicare Advantage insurance pays the full amount.  It differs from standard Medicare (usually) in picking up the rest of the tab except for copays.

You have a beautiful dog.

[kickingandscreaming]

You have a beautiful dog.

Thank you.  Yes she is--inside and out.  She's 14 now so she's getting a little long in the tooth.  But she is wonderful.  Her mother was mostly Whippet, but a Pit Bull and a Shepherd got into the act too.  And who knows who else?  She's a pure and delicious mutt. I hope she lives in good health for a long time.