Liver Transplant

Financing a Liver Transplant

Financial Considerations

Liver Transplant Costs

Cincinnati Children's Hospital Medical Center is committed to helping our patients and their families understand all of their options and identify potential sources for financial assistance.

Liver transplantation and the long-term follow-up care can be very expensive. A liver transplant for a child costs approximately $150,000 to $200,000 and immunosuppressive medications can be an additional $20,000 a year.

Medical Coverage

Our transplant financial managers are part of the Pediatric Liver Care Center Team. They are involved with you and your family from the very beginning of your transplant experience. They work closely with you to help you understand your coverage, whether it's through Medicare / Medicaid or an insurance provider. They will also work with you to identify additional financial resources if needed.

When you are referred to Cincinnati Children's, our transplant financial manager will contact you and ask questions to get an overall understanding of your medical coverage and transplant-related benefits. We will also contact your insurance provider for important information such as:

The name of your case manager (Most large insurance companies have someone dedicated to your case.)
The insurance companies' approval process for the various stages of transplantation: evaluation, surgery and follow-up care
How the insurance company pays their bills
Specific requirements of your provider regarding how billing information related to your child's care needs to be communicated, etc.
If a "re-insurer" or "stop-loss" company will be involved (a second insurance provider who backs up a company that is self-insured for high-cost admissions or procedures such as a liver transplant), we will work with them to determine what information is needed to administer your coverage

Your insurance provider might access a transplant network. These are independent groups that look at various aspects of a transplant program, such as credentials of doctors, outcomes, overall effectiveness of the program and communication.

They use this information to identify "Transplant Centers of Excellence" and negotiate a financial package for families the network refers. Cincinnati Children's is included in many of these centers of excellence.

When you come in for your child's evaluation, your transplant financial manager will meet with you to discuss your medical coverage. The information provided by your insurance company will identify if there are any gaps in your coverage.

These gaps may include limited medication coverage, high co-pays, lifetime coverage maximums that won't cover your child's needs and coverage limits for certain aspects of treatment. If needed, we will help you look for alternative financial resources and help you get these requests started.

Financial Assistance Programs

Even if you have good insurance coverage, there will most likely be many uncovered expenses during your child's care. Long distance phone calls, meals, housing costs and gas are just some examples.

Our social worker and transplant manager will help you find financial assistance opportunities such as charitable organizations or fundraising. They are experienced in these areas and will work with you to find the information you need.

Each state has a Bureau for Children with Medical Handicaps or a Special Children's Fund. These are state-funded organizations that provide financial assistance to children with chronic conditions.

In most cases, there is a financial need component to this assistance, but they may be another source of financial support. Financial assistance may be available for aspects of care that may not be covered by your primary insurance provider, such as co-pays, physical therapy and special infant formula.

Making Payments

To simplify the process of keeping up with bills during the transplant process and to take pressure off of parents, Cincinnati Children's handles billing for transplant patients.

Your transplant financial manager will take care of sending necessary paperwork to your insurance providers and following up on any reimbursement issues. You will receive a notice from your insurance provider indicating when a payment has been issued.

Changing Insurance / COBRA

There are many things to consider when deciding whether to change insurance coverage or choose COBRA coverage. Your transplant financial manager can help you with this important decision by explaining things you should consider, such as the lifetime maximum of the plan, out-of-pocket costs coverage, pharmacy coverage and pre-existing condition clauses.

We will help you evaluate how an insurance plan or COBRA coverage will affect you and your family. For instance, as part of your insurance plan you may have to pay 10 percent of your prescriptions, but they may require that you pay for the entire amount up front and then be reimbursed. If your medications cost $1,500 a month, you will have to be prepared to pay that amount.

Our financial experts also can help you evaluate the pros and cons of applying for COBRA versus switching to a plan through a family member or partner or whether it would be beneficial to have your child with the liver condition (but not the entire family) covered under COBRA.