You or your family may have health insurance coverage through an employer or a personal policy. Many insurance companies offer at least optional coverage for transplant costs. In some cases, insurance companies may pay about 80 percent of your hospital charges.

Insurance Cap

An insurance cap is the total amount of money your providerwill pay out in your lifetime. After you have reached this amount, the insurance company does not have to pay any additional benefits. The amount of the cap varies greatly, depending on the individual policy. The cap may apply to a single procedure or treatment or to all combined procedures and treatments. The ongoing costs of post-operative care may exceed the cap, so it is important to monitor your insurance policy.

Clinical Trials

Some insurers consider certain transplant procedures “experimental” or “investigational” and do not cover these cases. If you have any doubts about how your coverage is determined, contact your insurance company.

Sometimes you may be asked if you would like to participate in a clinical trial. Your financial counslor can help you determine your financial eligibility for clinical trials.

Many companies require prior authorization (approval) for organ transplant procedures. Delays in insurance payments can cause you unnecessary stress, so make arrangements with your insurance company prior to the transplant. Our financial counselor at transplant centers will help you with the information you need to complete this process.

Insurance Coverage by COBRA

If you are insured by a group health plan (medical, dental, or vision) through your place of work and you must leave your job or have your work hours reduced, you and your family may qualify for extended coverage through COBRA.

COBRA, Consolidated Omnibus Budget Reconciliation Act of 1985, contains provisions giving certain former employees, retirees, spouses and dependent children the right to temporary continuation of health coverage at group rates for 18 to 36 months when benefits would otherwise end. This requirement is limited to companies employing 20 or more people. This coverage, however, is only available in specific instances. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees, since the employer formerly paid a part of the premium. It is ordinarily less expensive than individual health coverage.

If you are considered disabled under Social Security guidelines at the time you leave your job, you may choose to continue your health coverage for up to 29 months, after which you become eligible for Medicare. If you leave your job because of your disability, you may be able to keep your life insurance if your policy has a disability waiver. You may do this as long as you notify your insurer and provide proof of your disability.

In addition, the spouse and dependent children of a qualified employee are eligible for up to 36 months of COBRA coverage. Additional qualifying events for spouse:

• covered employee being entitled to Medicare
• divorce or legal separation
• death of covered employee

In addition to the above, dependent children qualify if they lose their dependent status under the plan rules.

Deadline for Choosing Extended Coverage

By law, you have 60 days from the day you leave your job to decide whether to continue participating in your health plan through COBRA. When you leave your job, your employer must notify you of your right to continue coverage, how much you premium will be and where payment should be made, if you do not respond within 60 days, you cannot extend your benefits.

You may be able to convert your policy to an individual policy at the end of your coverage period. If you are eligible to continue coverage through COBRA, you should receive information from your employer telling you how to participate. if you have additional questions, check with your employer. Coverage may end before the maximum time limit in any of the following cases:

• the premium is not paid
• the company holding the policy stops offering an employee group health plan
• a covered beneficiary joins another group health plan
• a covered beneficiary becomes eligible for Medicare
• the company holding the policy goes out of business