Insurance and Financial Information for Transplant Patients

As a transplant patient, you have an important role in the financial aspects of your surgery. It is your responsibility to know your available insurance benefits and to review the information sent to you. You are also responsible for informing your credit analyst of any additional insurance you may have, and for reporting any changes in your insurance coverage.

Taking an active role in the reimbursement and payment processes helps your financial affairs run more smoothly before and after your transplant.

Start Your Transplant Journey

Your Transplant Credit Analyst

The cost of transplant surgery, which includes pretransplant evaluation and follow-up care, may be very high. You need to know how much of the cost of your transplant will be paid by insurance and how much you will have to pay.

You will be assigned to a specific credit analyst to help you understand your expected insurance coverage and out-of-pocket costs. This analyst will be your contact during the entire transplant process. Your credit analyst specializes in transplant referrals and transplant-related insurance benefits.

Requesting your insurance benefit information

Before your transplant evaluation is scheduled, information such as your age, address, employer, marital status, Social Security number, and insurance will be provided to your credit analyst.

Your credit analyst will contact your insurance company to learn what benefits are available for your transplant. If you already have an insurance case manager, UPMC can work closely with the manager to coordinate your benefits.

Information obtained by your credit analyst may include:

Basic outpatient drug and laboratory work coverage.
Co-insurance or other insurance supplements.
Deductible amounts.
Dollar or day maximums for coverage.
Effective date of insurance coverage.
Organ/tissue procurement coverage (charges for organ/tissue recovery and transporting the organ/tissue to UPMC).
Patient transportation coverage.
Pre-certification requirements.

Your credit analyst may request other information as well.

Understanding your insurance coverage

Because the transplant process is very complex, it may take your credit 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.

After your insurance investigation is complete, your credit analyst will inform your transplant coordinator of your financial status. When your financial status is approved, you will be contacted to arrange for your evaluation with the transplant team.

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

Insurance coverage confirmation documents

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 credit analyst is unable to reach you. Please return this letter to your credit analyst immediately. It will be kept on file at UPMC Patient Business Services.

Your packet will include the name and phone number of the credit analyst handling your insurance information. Contact this analyst if you have any questions about your coverage.

Alternative financing options for uninsured or underinsured transplant candidates

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.

Only after the alternatives have been exhausted will you be required to deposit funds in advance for a possible transplant. These funds are a source for payment of the hospital and physician bills; however, they may not cover all of your bills.

Billing and Payments

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.

Understanding your transplant bills

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 may also contact you during billing to help prevent delays in the processing of your insurance claim.