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The financial process begins when a patient is referred for transplant consultation or evaluation. When the transplant coordinator receives a referral for a potential transplant candidate, the next step in the process is financial verification and authorization.
The financial coordinator will keep the patients and their physicians apprised of any financial issues. These may include re-direction to another transplant facility due to contracting, limitation of benefits, or counseling for obtaining initial insurance coverage. We are available to counsel those patients who have no current coverage, or limited coverage, for transplantation.
We're with you all the way
Once benefits are verified and authorizations are obtained, the patient is scheduled for any necessary consultations and procedures. While our patients explore the possibility of transplantation and focus on their medical condition, we handle the insurance coordination and ensure that all necessary approvals are in place.
When all required testing is completed, a patient is presented to the selection committee for candidacy. If the committee is in agreement, a patient will be listed on the UNOS wait list. At that time, we will coordinate appropriate approvals for transplantation. This approval process will encompass all plans under which a patient is covered. Follow-up approvals are obtained as necessary for procedures, as well as maintaining current transplant approvals.
We are also available to assist when a patient is adding, changing, or losing insurance coverage. We ask that patients call us before they make any changes in health coverage in order to maintain accuracy and timely approvals for their care.
Paying for medication
Check your insurance prescription coverage to find out what your co-pay will be for generic and name brand medication. What can look like a low co-pay can actually add up to several hundred dollars a month. It is important that you know what you will be responsible for paying each month. If you have Medicare you will need to make sure you enroll in Medicare Part D - the prescription program.
Most drug companies have patient assistance programs to help people who cannot afford to buy their medicine. The following web sites offer a database of patient assistance programs along with information regarding each program's qualification rules and forms.
Anytime you feel the need to discuss insurance, disability, or other financial concerns. Always call us if your insurance is ending, changing, or if you are adding additional coverage.
What do I do if I don't have any medical coverage?
Call your financial coordinator to discuss what options may be available to you, including Medicare, Medi-Cal, High-Risk, or possible employer coverage.
When should I apply for Social Security (SSI/SSDI)?
In most cases, you'll want to apply for Social Security when you first become disabled, as it can be a long process. However, please contact your financial coordinator before applying as there may be unusual circumstances that may warrant starting another process first (i.e., the need for other health coverage). For those receiving Social Security for disability, Medicare will not begin for two years after the qualifying date of coverage.
When is Medicare my primary insurance coverage?
For those patients who are covered for disability, Medicare will remain secondary if you have a large active group employer plan (through yourself, a spouse, or a parent). Medicare will be primary from initiation if you are covered by an individual, small group, retired, or COBRA plan.
Can I give my new insurance information to the hospital or clinic?
You should always give your new insurance information to the hospital and clinic when you are being seen, but you also need to give it directly to the financial coordinator as it may not be received by the transplant team and proper authorizations may no longer be in place.
To reach one of our transplant financial coordinators, please call 650-725-5238.
After receiving a lung transplant at Stanford Health Care because of cystic fibrosis, Erinn Hoyt participated in the 2017 World Transplant Games.
Clinical trials are research studies that evaluate a new medical approach, device, drug, or other treatment. As a Stanford Health Care patient, you may have access to the latest, advanced clinical trials.
Open trials refer to studies currently accepting participants. Closed trials are not currently enrolling, but may open in the future.
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