Finances and Insurance
A blood stem cell transplant is an expensive medical procedure. Depending on the transplant center, the length of your hospital stay, and any complications, the treatment can cost hundreds of thousands of dollars.
Although insurance may cover most of the medical costs, a transplant also involves many out-of-pocket expenses such as parking, meals, temporary lodging, childcare, and others that can start to add up. It’s easy to be overwhelmed by the costs of a transplant.
Financial Aid & Fundraising
Even if insurance covers most of the cost of your transplant, you will probably have to pay part of the medical expenses out-of-pocket. Insurance co-payments, deductibles and uncovered expenses can quickly add up. In addition, your daily living expenses may be higher, particularly if your transplant is out of town. If you or a family member needs to stop working temporarily, your income will be less and can add to the financial strain.
Be sure to check with the transplant center social worker about financial assistance. Some transplant programs have special arrangements with local hotels that offer free or low cost lodging; offer help with parking; provide food vouchers for cafeteria food; or know of local funds that can help patients with expenses.
Check BMT InfoNet's Resource Directory for the names of organizations that provide financial aid or fundraising assistance to transplant patients and their familes.
If you are having a transplant using an unrelated donor, the Be the Match Donor Search Assistance, and Transplant Support Assistance funds help with donor search costs and expenses such as food, ground transportation and prescription co-pays for the first six months after transplant. Call Be the Match at 888-999-6743 for more details.
Understanding your benefits and rights from insurance is often confusing and overwhelming. Working with your insurance company early in the process is critical. Transplant centers usually require that insurance companies pre-approve the procedure before they begin your transplant.
Your transplant center will contact your insurance provider and send the necessary information about your diagnosis and type of transplant proposed. Depending on your insurance, the plan may cover all or only part of the treatment. Be sure to check if a spouse’s separate insurance plan, offered through their place of employment, has better coverage. If it does, consider moving under that coverage during an open enrollment period.
If You are Denied Coverage
If your insurance plan denies coverage of all or part of your treatment, you have a right to appeal that decision. Common reasons given for denying coverage are that the insurance company considers the procedure experimental or not medically necessary. Often, additional information from the transplant center will resolve the issue.
The specific steps you must take when filing your appeal are outlined in your insurance contract and must be followed carefully. Your transplant center may help you file the appeal. If you are unsure about how to file your appeal, organizations such as the Cancer Legal Resource Center, the Patient Advocate Foundation or Your Benefits Advocate can help. If you need a referral to an attorney with experience in these matters, please contact BMT InfoNet at 888-597-7674 or submit your request for help online.
If You Have No Insurance
If you have no insurance, you may be eligible for government sponsored insurance plans. Healthcare.gov is a web site designed to help you find insurance options.
Two federally funded research programs at the National Institutes of Health offer transplants free of charge to patients who qualify for one of their research studies. Contact that National Cancer Institute and the National Heart, Lung and Blood Institute for information about current studies and eligibility requirements.
Employment and Disability
While you or a family member is hospitalized, you may be entitled to employment protections and disability benefits. If you are the patient and continue working after your transplant, you may be entitled to accomodations at your work place to enable you to perform your duties. Our webcast, Employment Rights and Disability Insurance, discusses these protections and benefits in detail.