Transplant benefit examples

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

Below are three examples of member costs related to transplant facilities. These examples are for demonstration purposes only. Member health coverage varies by plan.

Example 1

Liver transplant average cost: $577,100* (cost includes surgery-related charges and six months of care after discharge)
In-network benefit – Humana National Transplant Network (NTN) 100% coverage
Member responsibility – In-network (NTN) $0
Out-of-network benefit 70% / 30%
Member responsibility – Out of network $173,130

Example 2

Kidney transplant average cost: $262,900* (cost includes surgery-related charges and six months of care after discharge)
In-network benefit – Humana National Transplant Network (NTN) 90% coverage with a $5,000 out-of-pocket maximum
Member responsibility – In-network (NTN) $5,000
Out-of-network benefit Deductible + $35,000 benefit per calendar year for transplant-related services
Member responsibility – Out of network $227,900

Example 3

Autologous bone marrow transplant average cost: $363,800* (cost includes surgery-related charges and six months of care after discharge)
In-network benefit – Humana National Transplant Network (NTN) $3,000 deductible/maximum out-of-pocket amount
Member responsibility – In network (NTN) $3,000
Out-of-network benefit $5,000 deductible/maximum out-of-pocket amount
Member responsibility – Out of network (Non-NTN) $5,000 + balance billing for charges in excess of usual and customary

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

*Source: Bentley, T. Scott, Hanson, Steven G., "2011 U.S. Organ and Tissue Transplant Cost Estimates and Discussion," Milliman Research Report, April 2011