It’s the time of year when many people are choosing their health insurance plans. But for patients awaiting a transplant, there’s an additional layer of research that can impact both their care and their finances.
DonorConnect wants to ensure all Utahn's don't skip this important step which critical for anyone who may face a transplant.
“Transplants have their own little tricks in them, and you cannot do things like look at the regular list of locations to see if something’s in network,” said Rebecca Yates, owner and founder of Ark Insurance Solutions.
Yates says it may surprise people to learn that a transplant center can be out-of-network even if the hospital is in-network for other services.
“Each carrier will have their own transplant network,” she said. “That transplant network will tell you — it’ll give you some boxes and you can check adult, pediatric, whatever organ you’re happening to be on the list for, and then it will tell you if it’s going to take this facility or not and what type of insurance. So it’ll say Medicare’s covered, ACA’s covered, commercial’s covered.”
Failing to check those details could leave patients responsible for the full cost.
“So if the transplant would cause financial harm to the consumer, they just won’t put you on the list,” Yates said.
Her biggest recommendation: seek guidance from someone who specializes in this area.
“I would recommend using an agent or broker that is trained, specifically trained, in transplants, rare disease communities,” she said. “Find someone who knows what they’re doing. Don’t be afraid to ask them if they have experience in it.”
For those who want to research on their own, Yates says there’s a simple approach.
“Just Google this insurance company’s name and then ‘transplant network list,’” she said.
The transplant community may be small, she added, “and I’m so glad we don’t have more people that need transplants.” But for those who do, confirming coverage early can make a world of difference.
“Every second on that list matters,” Yates said. “You do not want to have to wait until open enrollment in a year to get on the list.”