Financial Matters Related to Bone Marrow Transplants
Work or Leave of Absence
Proceeding with a transplant will require you to be away from work for a period of time. A minimum expectation for an autologous transplant is six weeks, whereas the time off of work for patients receiving an allogeneic transplant can range from three months to a year or more. Your transplant physician and coordinator will inform you about the time they would expect for you to be off work.
You will need to contact your employer’s Human Resources Department to ensure continuation of your employee benefits and to obtain information regarding medical leave and disability. If you are having difficulty understanding this information, please contact the Transplant Social Worker for assistance.
Insurance Patients: Please note, your insurance is a contract between you, your employer and the insurance company. Our relationship is with you, not your insurance company.
It is important for you to read your plan’s benefits, and rules and regulations. We provide the service of a Transplant Financial Coordinator and Social Worker to assist you as needed, but it is ultimately your responsibility to understand your insurance policy.
Be sure to inform your Transplant Financial Coordinator of all health insurance policies you have and if you expect any changes in coverage during your transplant.
Patients covered under managed care plans (HMO/PPO/EPO’s) are responsible for complying with their insurance rules regarding referrals from primary care physicians to see specialists.
Failure to comply with your insurance requirements will make it necessary for us to bill you directly for charges incurred during a non-referred, non-covered visit.
We will file and process claims for insurance companies with whom we have contracts. Otherwise, payment is expected at time of service. Upon request, a copy of the bill will be furnished to you for insurance claim filing.
Co-payments are required to be paid at the time of service. Co-payments can be expected for each office visit, treatment, and often times lab services.
You are responsible for deductibles, co-insurances, and services or procedures not covered by your insurance company.
If at any time you or your spouse are eligible for COBRA coverage or are considering changing insurance providers please contact the Transplant Financial Coordinator prior to your selection.
Obtaining Insurance Approval for Transplant
A financial coordinator or your transplant coordinator will obtain information about your insurance coverage. Even if you are still deciding whether or not you want to have a transplant, it is a good idea to determine what insurance coverage you have for the procedure.
Approval for payment of transplant expenses by your insurance company does not mean that you have to proceed with the transplant. Please do not confuse this initial review of benefits with “preauthorization” or final approval by your insurance company. Almost all insurance companies require a detailed review of your case by an insurance physician prior to actual approval for transplant and related services.
Preauthorization by your insurance company means the company agrees that a transplant is medically necessary and the appropriate treatment for you. However, payment for your treatment is still based on your individual policy. You may be responsible for part of the payment or for related services.
Our goal is to limit your out-of-pocket expenses as much as possible and to keep you informed about our interactions with your insurance company. (Personalized financial counseling is available for patients).
Do not be discouraged if your insurance company initially declines to cover the cost of your therapy; often they only need more specific information to understand why you are an appropriate candidate for this treatment. We will provide them with the necessary information and keep you informed of the process.
Insurance companies often limit the money they allocate for your treatment to specific services. This means that some things, including housing, dental exams, and outpatient prescriptions, may not be covered. We will do our best to let you know as soon as possible about any restrictions. However, it is your responsibility to understand the provisions and restrictions of your policy.
The best way to get information regarding your policy is through your employer’s benefits or human resources personnel or by calling your insurance company’s customer service line. You will also be assigned a case manager by your insurance; this person will be a good resource for you once the insurance process begins.
You may be eligible for Social Security Disability and/or Supplemental Security Income. The Transplant Social Worker is available to help you with determining your eligibility for these programs and can assist you in filling out the necessary forms. You may also have disability coverage through your employer. There are some limited community resources that may be available — please contact the transplant social worker for more specific information or eligibility requirements.
If you find that some services related to your transplant are not covered by your insurance policy, you may want to do some fundraising to help cover your out-of-pocket costs. Your transplant coordinator and the transplant social worker are available to discuss this option with you and to assist in whatever way possible. However, check with your transplant financial coordinator to see if fundraising may interfere with your insurance coverage before you begin.