Financial Considerations | Overview
Going through the transplant process requires detailed financial planning. The Pediatric Transplant Center's dedicated financial coordinator is available to guide you along the way.
Knowing ahead of time what to expect is an essential part of the process. The majority of insurance companies require prior notification for all transplant services. Some of the charges to expect include the evaluation process, surgery, hospital stay, follow-up care and medications.
Contacting your insurance company ahead of time is one of the most important things you can do to prepare for your child’s transplant. The insurance company will help you understand your individual coverage and benefits based around the transplant. You'll be responsible for all co-pays and deductibles after charges have been processed. Assistance is available for families who cannot afford these out-of-pocket costs.
Our financial coordinator will work with your insurance company to obtain prior authorization for transplant care and will appeal any denials if turned down for the procedure.
Our coordinator also can assist you in identifying additional financial resources needed during the process. Assistance is available if you have no insurance or limited benefits for transplantation. In addition, the coordinator will help you navigate expenses, denied services or general financial questions.
Call our financial coordinator at 617-355-0137 before your child’s evaluation if you:
- Have any questions regarding your insurance
- Do not have insurance
- Do not have benefits for transplantation
- Are denied coverage for a transplant
- Anticipate your insurance will be changing during the process
- If any of these situations applies to you, we'll walk you through your options, and how we can help.
Medicare & medicaid
Patients undergoing kidney transplantation are automatically eligible for Medicare coverage. For patients who already have private insurance, Medicare becomes primary coverage 30 months post-transplant. Applying for Medicare when this time draws near can help alleviate future financial strain and add assistance. Medicare Part A covers inpatient admission costs, and Part B covers 80 percent of charges that include outpatient clinic.
Medicaid may be an option for certain families with limited resources. Although Medicaid coverage is based on family household income, some families who don't meet the program's income requirements may still be eligible when transplant coverage is concerned. It will be essential to contact your local welfare office to see what type of Medicaid category you may fall under.
Social security income
If you're eligible, social security income can pick up out-of-pocket costs after Medicare payment; we can assist you in the application process and determining your eligibility. The Social Security information line can be reached at 1-800-772-1213 or online at socialsecurity.gov.
There are many local and national organizations dedicated to providing information, support and financial assistance to transplant recipients. Many pharmaceutical companies also provide assistance with medications. We encourage you to utilize these resources throughout the transplant process. Please feel free to contact your program’s social worker in the Pediatric Transplant Center directly if you have questions related to these resources. Note: This list is not an endorsement of services.
General assistance programs
- Healthwell Foundation
- The Massachusetts Rehabilitation Commission
- Children's Organ Transplant Association
- National Living Donor Assistance Center
- National Transplant Assistance Fund & Catastrophic Injury Program - 800-642-8399
- Needy Meds
- Patient Access Network Foundation
Medication specific assistance programs
- CellCept Medical Needs Program - 866-247-5084
- AbbVie Patient Assist (Gengraf) - 800-222-6885
- Amgen (Aranesp, Epogen) - 800-675-8416
- Novartis Patient Assistance Program (Neoral) - 800-257-3273
- Prograf Patient Assistance Program - 800-477-6472
- RapAssist Patient Assistance (Rapamune) - 877-472-7268 or 800-378-7645