Employer health insurance plans are offered through your job, your spouse's job or your parent's job. Plans vary by employer, and it's your responsibility to know the details of your coverage.
Insurance Questions to Ask Before Transplantation
We recommend that you meet with a representative from your employer's human resources department and get answers to the following questions before you receive a transplant at Rush:
- Is Rush is an approved health care provider for transplant in your network?
- Do you need a referral to see a specialist?
- What is your annual deductible?
- What are your maximum out-of-pocket expenses
- Do you have a lifetime cap on benefits?
- What is your prescription drug coverage, especially anti-rejection medications?
If you are enrolled in a health maintenance organization, you will be responsible for obtaining referrals from your primary care physician for your transplant evaluation and follow-up care.
More Than One Health Insurance Provider?
- If you are covered by more than one insurance provider, there are various rules that determine which one will pay for certain parts of your treatment.
- If you have coverage through two private insurers (typically one through your job and one through your spouse's), your insurance plan usually pays first, and your spouse's plan would be billed for anything that is left over.
- If you have Medicare and a private insurance plan, the private insurance plan pays the bills for the first 30 months of Medicare eligibility, then Medicare takes over. Since there are significant copays, it is important to keep your private insurance coverage, even after Medicare becomes the primary insurer.
- If you have Medicare and Medicaid, Medicare always pays your bills first and Medicaid pays what is left over.
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