Transplant Benefit Examples

Selecting a hospital to provide organ transplantation services can be one of the most stressful decisions one can make for their transplant needs.

Benefits for transplant services vary by product, plan, and employer. The cost of organ transplants can vary widely depending on which facility you choose.

Three Examples

Below are three examples of member costs related to selecting a transplant facility. Gray highlights represent examples of out of pocket costs for members who choose a transplant hospital that is in the National Transplant Network. Teal highlights represent costs that could be anticipated if a member chooses a hospital that is not in the National Transplant Network.

Example 1

Liver Transplant - Average Cost $388,600* for 1 year following transplant surgery

In Network - National Transplant Network (NTN)	100% Coverage
Member Responsibility - In-Network (NTN)	$0
Out-of-Network - Non NTN	70% / 30%
Member Responsibility - Out-of-Network (Non NTN)	$116,580

Example 2

Allogeneic-Related Bone Marrow Transplant - Average cost $371,800* for 1 year following transplant surgery

In Network - National Transplant Network (NTN)	90% with a $5,000 maximum out of pocket
Member Responsibility - In-Network (NTN)	$5,000
Out-of-Network - Non NTN	Deductible + $35,000 per calendar year for transplant related services
Member Responsibility - Out-of-Network (Non NTN)	Deductible + $35,000

Example 3

Kidney Transplant - Average cost $190,400* for 1 year following transplant surgery

In Network - National Transplant Network (NTN)	$3,000 Deductible/Maximum Out-of-Pocket
Member Responsibility - In-Network (NTN)	$3,000
Out-of-Network - Non NTN	$5,000 Deductible/Maximum Out-of-Pocket
Member Responsibility - Out-of-Network (Non NTN)	$5,000

For further information concerning your transplant benefits, please call 1-866-421-5663.

Source: Milliman*
2005 US Organ and Tissue Transplant Cost Estimates and Discussion

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