Health Insurance Decisions

When an individual is faced with a long-term life and death situation, how does the health insurance provider respond? There are many individuals today that are candidates for such medical necessities as a heart transplant, liver transplant, and kidney transplant. These bring about the uncertainty of the individual and the medical health insurance provider because there are no set pattern of rules involved.

How are individuals matched up with a donor organ? Does the health insurance provider play a role in the decision along with the team of medical health care physicians? There is such a delicate balance involved between the donor and the prospective recipient. Kidneys from a donor can last up to seventy-two hours, while a liver will only be survivable for twenty-four hours.

The relationship between the health insurance provider, the team of medical health care physicians, and the recipient of the transplant must remain in close contact for the procedure to be effective for success. The considerations on the part of the health insurance provider are.

1.    Complications after surgery

2.    The severity of rejection episodes

3.    The length of the individuals hospital stay

4.    Difference in cost from one hospital to another

However, these are major details the individual, the health insurance provider, and the medical health care physicians would have discussed before any medical health care procedures were to take place.

The majority of transplants are paid through the individual’s private health insurance provider. There are other circumstances when the Medicare health insurance and the Medicare Health Insurance programs will be responsible for certain transplants procedures.

What is important is to fine tune and discuss all possible procedures and outcomes before you even agree to any transplant surgery. In most cases, the more information an individual can ascertain before the actual medical health care surgical procedure, the more positive the outcome. This is when the individual will find out how much of the transplant surgery the health insurance provider will be responsible.

What does become important is where you are to have the medical health care surgical procedure done. When a medical health care physician and partnered hospital are within the network of medical health care providers offered by your health insurance provider, the reimbursement factor will be much higher. This will save you from having to pay thousands of dollars out of pocket. Obviously, when your medical health care physician and participating hospital are out of the agreed to network, it will cost you dearly.