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PKD Discussion Forums - View topic - Who pays for a 'prophylactic' transplant

Who pays for a 'prophylactic' transplant

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Posts: 59
Joined: Fri Dec 20, 2013 8:20 pm

Who pays for a 'prophylactic' transplant

Postby ganncamp » Fri Dec 20, 2013 8:36 pm

I know that once you reach End Stage Renal Disease, Medicare (Medicade? whichever) takes over for dialysis, transplant &etc.

I've been told that "they don't make you wait anymore for your kidneys to fail before you can get a transplant."

But I don't know who "they" is. Is that the maintainers of the waiting list? Is that Medi-whatever? Both?

If I can find a living donor, who pays for the transplant and/or how much do I have to save/win in the lottery/steal from the bank?

risasimon

Re: Who pays for a 'prophylactic' transplant

Postby risasimon » Wed Dec 25, 2013 8:52 am

Your transplant center will guide you accordingly. Not sure what you mean about a "prophylactic transplant?" I think you mean a "preemptive" transplant (which is a transplant before you reach the need for dialysis). Insurance doesn't pay for a transplant until you are at 20GFR which is also when you can be actively listed. Yet, you can start the evaluation, get approved, get potential donors tested and approved before then. Most likely you won't be scheduled for the surgery until you are at 20GFR. After transplant you'll then apply for Medicare (and I believe they only give you a couple of weeks to do that), through social security. Medicare pays in the rears from transplant day forward, for 36 months total. It is a "secondary" to your primary insurance for first 20 months and then primary for last 6 months. It's the way they coordinate ESRD medicare benefits. Both you and your donor's surgeries are covered this way. Hope this helps! :D

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Posts: 10
Joined: Wed Dec 25, 2013 8:56 am

Transplant Insurance Coverage

Postby risa simon » Wed Dec 25, 2013 9:31 am

Risa Simon, Volunteer Phoenix Chapter Coordinator
Patient Mentor, Speaker, Author: "Shift Your Fate: Life-Changing Wisdom For Proactive Kidney Patients"
http://www.amazon.com/gp/product/0578113635

Posts: 59
Joined: Fri Dec 20, 2013 8:20 pm

Re: Who pays for a 'prophylactic' transplant

Postby ganncamp » Sun Dec 29, 2013 12:14 pm

Thanks Risa! That's exactly what I needed to know.

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Posts: 10
Joined: Wed Dec 25, 2013 8:56 am

Preemptive Transplant

Postby risa simon » Tue Apr 15, 2014 8:18 pm

You're most welcome. Another "work around" to timing that I didn't mention in my previous post, has to do with symptoms or conditions that might warrant a transplant before 20GFR. For example, there may be serious issues with pain, organ crowding or other factors that might be worth pursuing with your transplant team (or highlighted for the evaluation committee) in respect to your "quality of life."
Risa Simon, Volunteer Phoenix Chapter Coordinator
Patient Mentor, Speaker, Author: "Shift Your Fate: Life-Changing Wisdom For Proactive Kidney Patients"
http://www.amazon.com/gp/product/0578113635

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