Insurance and Transplant Coverage Information

If you and your doctor are considering a bone marrow or cord blood transplant (also called a BMT), then you may have a number of questions. You are probably learning more about the BMT process. You might also be wondering what expenses are involved in getting a BMT and whether or not your insurance will cover such costs.

If you have no health insurance, call your county human services department to see if you qualify for state medical assistance or other help. For information about other programs that may be available to help, go to the Patient Advocate Foundation Web site at www.patientadvocate.org/resources.php.

Evaluating your health care plan

Every insurance company pays for the transplant process in different ways — some pay for all of it, some pay for part of it and some do not pay for it at all. It is very important to find out early what transplant expenses are covered. Here are some steps you can take to learn about your insurance coverage. It may be a good idea to ask a trusted family member or friend to help you so that you can focus on your health.

Read any written information that has been given to you explaining your plan.
If you have insurance through your workplace, ask to speak with the person or department in charge of benefits. He or she may be able to help you with insurance coverage questions.
Ask for a financial representative at your doctor's office, hospital or transplant center. He or she will be able to assist you with questions and can also tell you about any costs you will be responsible for paying.

Services that may not be covered

You may want to ask if the following items are covered by your specific health insurance plan:

Testing to find a matched unrelated or related donor or cord blood unit
Donor costs
Transplants for a rare diagnosis
Travel and lodging expenses to and from the transplant center for patient and/or caregiver
Food costs while staying near transplant center
Parking costs
Prescriptions for post-transplant discharge or outpatient medications
Office visits coverage
Home health care
Psychiatric coverage
IV Neupogen injections
Procurement of cells from the donor
Harvest/storage fees prior to transplant
Backup collection of cells
Clinical trials
Sperm/egg storage
Insurance premiums when patient is not employed
Fees for post-transplant home preparation (carpet and drapery cleaning, replacing filters on heaters, air conditioning cleaning)
Change in cost of living after transplant (different food needs, for example)
Wigs
Child-care costs

If your insurance does not cover all of your costs related to transplant, you may be eligible for Financial Assistance for Transplant Patients.

A marrow or cord blood transplant for United States citizens or residents is usually paid for through private or government insurance programs. If you are not a United States citizen or resident, check with your government or healthcare provider about transplant coverage outside of your country. If you will be going to a transplant center outside of your country, you may need to make a large financial deposit or pay for the transplant in full before being considered.

Contact your insurance company

Contact your insurance company. Ask for your case manager. If you do not have a case manager, ask for one to be assigned to you. He or she may help you understand your coverage and/or what steps you need to make sure the costs are covered when the bills come in.
Keep good notes of any conversations you have with your insurance company.
Record the dates of your conversations and names of persons you speak to.
Ask for all information in writing.

Resources

Need help? Contact the NMDP Office of Patient Advocacy and ask to speak to a financial case manager.

To ensure that you get the maximum insurance coverage possible, the NMDP Office of Patient Advocacy has staff available to help you through the process of considering a bone marrow or blood cell transplant. Staff can provide information to help you sort through financial and insurance issues and can act as your advocate when you talk to your insurance company.

For more detailed information, download the Transplant Coverage Information Worksheet (PDF), which may be helpful to you in working with your insurance provider or payor.
Choosing a Transplant Center: A Patient's Guide provides a variety of information about all transplant centers in the United States that access the NMDP Registry of potential donors.
Mapping the Maze: A Patient Financial Guide can help patients understand their bone marrow, blood cell or cord blood transplant health insurance coverage, learn about financial resources and develop a financial plan for transplant expenses.

Insurance and Transplant Coverage Information

On this page:

Evaluating your health care plan

Services that may not be covered

Contact your insurance company

Resources

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