One person's story of a liver transplant...complicated...no problem with the surgery being approved, all the action takes place after the fact with getting the drugs needed post surgery...and the hospital has someone on staff to help patients with the battle getting the meds they need...more expense for the hospital and surely not a pleasurable experience for the patient...the captive audience here for lack of a better description...BD
If there’s one thing everybody knows about those of us who have body parts replaced, it is that we have to stay on anti-rejection meds the rest of our lives. One slip and our immune systems go haywire and try to expel the alien organ. Rejection is NOT fun: you get two grams (yes grams) of a IV form of prednisone (Solumedrol) dumped into your veins, lose what little is left of your immune system and go stark raving bonkers in the meanwhile. I’ve seen people in 9 Long - the transplant floor of UCSF’s Moffitt Hospital - suffering through this madness. They don’t mess up their rejection meds again.
“Don’t worry!” said the counselor. “The insurance company will likely want a second opinion and that’s normal. But you shouldn’t have any trouble getting approved.” “Then things are going ok.” I looked at him puzzled. “Believe me,” he said. “We wouldn’t be doing anything for you if the insurance company wasn’t funding it.”
Obviously I made it through the approval, a liver was found, and the transplant happened, all without a peep from HealthNet. I was as amazed by their silence as I was by having my body ripped open and an organ replaced. Transplants, especially liver, are expensive (there’s a lot of cutting and pasting involved in switching livers) usually to the tune of $400,0000 to half a mil. And the insurance company never squeaked? Wow.
A few weeks later, I’m out of the hospital recovering well (this is before my other complications set in) and I go to fill my prescriptions for the anti-rejection meds. Denied, said the pharmacy. Not part of HealthNet’s formulary, it seems. Medications deemed not necessary, it seems. How could HealthNet not even squeak about dropping $400k for the part swap but now balk at a few hundred dollars for the meds needed to keep it functioning? Huh? Huh?
My Myfortic, one of my anti-rejection meds, has gone from $7 copay to $170.....UCSF has a person dedicated solely to deal with financing transplants so it has a person whose job is to make sure those same companies don’t cut off transplantee’s meds after the transplant’s done.
Sheesh. God may bless America, who knows (I have my doubts). But she clearly forgot to include our health care system.