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| see earlier Crabgrass post, here |
Start with opinion, here, factual reporting, here. Appropriate to Dick Cheney (our nation's most recent 71 year old heart transplant recipient of note), both items are online at the Daily Beast.
An east coast University hospital's FAQ page on heart transplants, here, contains much of interest beyond this single question-answer pair:
What part of the transplant is covered by insurance?
There are no simple answers to this question. First, you must answer some questions yourself. Do you have insurance? If so, you must read your policy book. If you do not have one, contact your broker who sold you the policy or contact your employer benefits unit. This is your transplant and you need to be involved in learning about many aspects of transplant, including insurance.
Review your plan to answer the following questions:
* Is transplant a covered benefit?
* Is a heart transplant covered by your health plan?
* Is there is a life-time maximum (amount of total dollars plan will allow for transplant)? What is it?
* How are prescription medications covered? Does the insurance plan cover medicine directly or is medication subcontracted to a "Pharmacy Benefits Manager"?
* Is the medication included in the lifetime maximum?
* Can you go to any transplant program or does your insurance limit you to only specific, designated hospitals?
* Will your policy cover the transplant at UMMC?
* Do you have an insurance case manager?
* What is his/her name and number?
There are as many different insurance plans as there are patients, so we can't discuss all the details here. Our finance coordinators and other benefits staff can work with you, but we expect you to do the basic research about your insurance.
There seems a flavor of why a universal all-are-equal single payer-provider might be best - unless you are in the 1%. But for the 99% - it's check out your health coverage, if you have any, for how transplant surgery for you or a covered family member is hedged and constrained, vs. open and available. With "as many different insurance plans as there are patients," is it presently like trying to shop for a decent used car where a problem is finding an honest dealer as a first step?
That FAQ page from the Maryland hospital is informative.
So, you are living in Ramsey's Northfork neighborhood, smiling smugly in your still highly mortgaged McMansion; well let the American Organ Transplant Association have a go at that smug smile:
The approximate costs related to major organ transplants include: $650,000 for a heart transplant, $500,000 for a liver transplant, $400,000 for a lung transplant, and $250,000 for a kidney transplant. The costs identified are only related to the hospital and medical personnel fees. Tests preformed prior to the transplant and follow up treatments related to the procedure will add more to the final cost. In addition, the transplant patient can expect to have the lifetime cost of the prescription medications necessary to support their organ transplant.
Transplant candidates that are covered by Medicare or Social Security benefits will need to contact these agencies to determine the coverage of organ transplant costs. The Veterans Administration will provide assistance for transplant costs through veteran benefits.
See: this link.
Perhaps the portfolio hit will not be as bad for some as it might be for others. Different pricing info, here, along with this quote:
Most transplants are paid for by private health insurance, although the Medicare and Medicaid programs pay for certain transplants for certain people. Many private insurers now cover heart transplants. However, you must contact your insurance company to know if you are covered and for how much. Some insurances cover you for less if you have the procedure done at a hospital outside their "system." This is the case for me.
Your heart transplant costs might be reimbursed by Medicare if you are Medicare eligible and the transplant is done at a Medicare approved center. Medicaid coverage for your transplant is decided by your state's State Medicaid program. If your state does cover your procedure, the federal government will provide funds on a matching basis.
Although legislation to change this is in the works, currently your meds are only covered by Medicare for the first 3 years, and then you are on your own!
When standing at the mercy of the insurance industry, remember they are such generous and caring souls, so you have little cause for worry. In our great US of A we treasure every individual and our market-driven healthcare set-up is the proof of that. Beyond doubt. Bless the insurers, and bless their insurance industry, for they shall inherit the earth.
Time for a wrap up - If you want to read more, see this Google, (from which earlier links were found). Do a web search on your own, something like "Cheney heart transplant," for further news and opinion coverage of our esteemed former Vice President and his surgery - news beyond what the Daily Beast had to say.