YOU ASK:

Is heart transplant covered by health insurance?

WE ANSWER:

Yes, heart transplants are covered by health insurance in most cases, especially if the insurance plan is comprehensive. However, each insurance company may provide the coverage differently. What you can do is check your policy as early as now to see what kind of coverage you are being provided by your policy.

In addition, the amount may be so big that the coverage provided by the health insurance may not be enough to pay all the expenses. Aside from your primary health insurance, you can also look into Medicaid as your secondary insurance, depending on the eligibility rules for Medicaid in your state.

Yes, if you think there is a strong possibility that you will need a heart transplant, you will need a primary health insurance and a secondary health insurance. That way, you are able to get as much coverage you need, provided that you coordinate your primary and secondary health insurance policies so that they cover as much ground as possible.

There are also other costs related to heart transplants that are not covered by health insurance. These may include:

  • Anti-rejection medications taken to ensure that your "new" heart is accepted by your body
  • Costs related to the heart donor, including harvest fees (the fees required to remove the viable heart from the donor)
  • Testing costs (to see whether you and the donor are compatible)
  • Food, lodging and travel expenses of the patient and caregiver (to and from the hospital or transplant center)
  • Outpatient medications while the patient is recovering
  • Visits to the doctor
  • Home care
  • Visits to the psychiatrist

Also, there may be instances where heart transplants are excluded, such as when the insured is over 65 years of age, overweight and may have been living an unhealthy lifestyle. In cases such as these, the insurance policy may deny your claims and refuse to pay these.

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