Since 2003, UNOS has required that transplant centers inform all candidates that they can be evaluated and listed at more than one center, and that they can also transfer their care from one center to another without losing the time they have accrued on the waiting list. However, not everyone can afford to fly around the country and be evaluated at more than one transplant center. In fact, many people can’t afford a liver transplant, period.
According to the most recent estimates, the cost of a liver transplant is $519,600—a price tag that excludes roughly one-third of Americans because they don’t have sufficient insurance (or any insurance), Caplan estimates. According to data collected for UNOS, only about 5% of liver transplants are paid for out of pocket.
“What your insurance covers is very different from everyone else’s,” says Anne Paschke, a spokesperson for UNOS. Some insurance companies won’t cover evaluations at multiple transplant centers, Paschke explains, and in at least one case, an insurance company has restricted its coverage to a single transplant center that the company itself owned.
Moreover, your insurance continues to be important during the evaluation process. The decision to accept a transplant candidate takes place before UNOS enters the picture, and the committees that determine whether a patient is added to the transplant center’s waiting list have access to a patient’s full medical and financial history.
“There’s a huge triage involved in getting in,” says Caplan. “If you’re a homeless alcoholic sleeping on the streets of L.A., and you’re going toe-to-toe with Steve Jobs, you’re going to lose.”
For most people, the ability to pay is a precondition for acceptance at more than one transplant center. Wealthy people who are, in effect, financially “pre-approved” for a liver transplant, can shop around and identify the transplant centers that will give them the best chance of receiving a new organ.
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