Transplantation Services

Financial Considerations for Reconstructive Transplantation

The cost of transplant surgery, which includes the transplant evaluation, the surgery (including acquisition of the limb), the hospitalization, outpatient testing, and follow-up care, may be very high. You need to know how much of the cost of your transplant may be supported by UPMC or available grants, how much will be paid by insurance, and how much you will have to pay. There are significant lifelong personal and financial responsibilities associated with transplantation.

Before your transplant evaluation is scheduled, information such as your age, address, employer, marital status, Social Security number, and insurance is sent to one of UPMC’s benefits analysts. These analysts deal only with transplant referrals and transplant-related insurance benefits. You will be assigned to a specific analyst. He or she will be your contact during the entire transplant process. It is helpful if you already have an insurance case manager. UPMC can work closely with the manager to coordinate your benefits.

Your benefits analyst will contact your insurance company and/or Worker’s Compensation carrier to learn what benefits are available for your transplant. Information obtained includes the following:

• effective date of insurance coverage
• deductive amounts
• co-insurance or other insurance supplements
• dollar or day maximums for coverage
• pre-certification requirements
• basic outpatient drug and laboratory work coverage
• organ/tissue procurement coverage (charges for organ/tissue recovery and transporting the organ/tissue to the UPMC)
• patient transportation coverage

Other information may also be requested.

Review and Clearance

Because the transplant process is very complex, it may take your analyst several weeks to learn the extent of your insurance coverage. A careful and complete investigation is to your benefit. Your analyst will work to obtain the information as quickly as possible.

Your benefits analyst will inform your study coordinator of your clearance status. When your clearance status is approved, you will be contacted to arrange for your evaluation with the transplant team.

Your analyst may send a letter to your insurance company to confirm your benefits. The letter helps to maintain clear communication between the analyst and the insurance company.

You will receive a packet of information that includes the following:

• a copy of the confirmation letter sent to your insurance company
• a letter listing your insurance benefits and pointing out any charges for your transplant that are not fully covered by insurance
• another letter requesting the name, address, and telephone number of a responsible person (a family member familiar with your medical condition and your financial and insurance status) who can be contacted if your benefits analyst is unable to reach you. Please return this letter to your analyst immediately, to be kept on file in UPMC Patient Business Services.

The name and telephone number of the analyst handling your insurance information will be included in your packet. Call this person with any questions you have about your insurance coverage.

If you do not have enough insurance coverage or have no coverage for transplant surgery, we will try to find possible alternatives for coverage and help to investigate them.

Billing Information

After your visits to UPMC begin, you may start to receive separate bills and statements from the hospital and from UPMC Physician Services. UPMC Physician Services is the faculty physician practice plan associated with the transplant program.

The hospital and the physician practice plans are separate from each other, with separate billing departments. The hospital will charge you for use of its facilities and services. The physician practice plan will bill you for services provided by doctors and staff. Knowing this difference may help to avoid confusion when you start receiving statements or bills. A representative from UPMC Patient Business Services also may contact you during billing to help prevent delays in the processing of your insurance claim.

As a transplant patient, you have an important role in the financial aspect of your surgery. You have the responsibility to know your available insurance benefits and to review the information sent to you. You also have the responsibility to inform your benefits analyst of any additional insurance you may have, and to report any changes in your insurance coverage.  You will be responsible for other costs which include, but are not limited to, travel to and from Pittsburgh, PA, your lodging, and your meals.

When you take an active role in the reimbursement and payment processes, you can help your financial affairs run more smoothly both before and after your transplant.

Who to Call

Call the following offices weekdays between 8 a.m. and  4:30 p.m., EST.