How Can Health Insurance Help Cover a Costly Organ Transplant?

Due to the complexity and expensive medical care, a critical disease can drain you physically, mentally and financially. Organ failure may also result from such circumstances. To help you pay for these medical costs, you should have a health insurance plan covering costly procedures. While awareness of life-saving organ transplant surgeries is expanding in India, only a few people know that these surgeries are covered under health insurance. Today, most general insurers include coverage for organ transplant surgeries in their standard policies. These also pay the expenditures of the organ donor; some offer to refund the full cost, while others set limits on these costs or offer it as an add-on.

To use your cover to its most potential, you must know the finer points.

Understand the Scope of Coverage for an Organ Transplant

To perform an organ transplant, both the insured recipient and the organ donor must undergo surgery. The plans cover every hospital charge the insured recipient incurs, including pre- and post-hospitalization costs, and medical and surgical costs. The costs incurred by organ donors for organ harvesting, including surgery and storage, are paid for. The former's treatment costs will be fully covered up to his/ her policy's maximum amount insured, but the insurer is responsible for covering donor costs. Up to a certain amount, hospitalisation costs for the donor are covered by organ donor insurance. There is no particular exclusion as long as the organ is given to the insured and the health insurance claim is acceptable under the terms and circumstances of the health insurance policy.

What is the Average Cost of an Organ Transplant in India?

The process of an organ transplant is fairly challenging since the doctors must determine whether the recipient and donor are a good match. The following is a list of some of the most common organ transplants and their typical costs:

What Accounts for Such a High Expense?

1. Organ Screening - Finding the proper organ is necessary before a patient is admitted to the hospital for an organ transplant.
2. Pre-hospitalization Costs - The patient undergoing surgery will need to be stabilized medically with medications and pre-operative care.
3. Hospitalization Costs - These payments include things like the cost of the room, a nurse or doctor, etc.
4. Surgery for organ transplants.
5. Hospitalisation and monitoring following surgery.
6. Rectification of postoperative problems

Additionally, costs for pharmaceuticals, ambulance services, pricey medications, extra care services in hospitals, etc., may also raise the expenses.

Important Things to Consider When Buying Health Insurance for an Organ Transplant

Health insurance, as told above, can help you cover the cost involved in organ transplant. But getting covered adequately and without any hassle depends on evaluating the plans based on the below criteria.

Coverage

Verify the policy's coverage of an organ transplant. The extent of coverage varies between insurers. Check if the coverage is adequate to cover the cost involved in an organ transplant.

Payable Premium

When choosing a health insurance policy for an organ transplant and other medical treatment, keep an eye on the premium too. Select the policy that covers you comprehensively against an organ transplant for an affordable premium.

Free Annual Health Check-ups

Check the policy document for any free annual health check-ups. These check-ups indicate to you the health issues you might face in the future. Claim-free years often lead to free annual health check-ups. Some insurers cap free health check-ups up to a certain amount.

Waiting Period

The waiting period may be different from one insurer to the next. It typically ranges up to 2-4 months before you can receive the coverage benefits. Choose a plan that covers life-threatening illnesses for the least possible waiting time.

Post-hospitalization Coverage

Typically, the coverage pays for any medical costs associated with an organ transplant procedure. If the donor develops a condition as a result of receiving an organ transplant or experiences a side effect, the policy does not cover it. However, some insurance providers provide extra protection, such as post-hospitalization coverage for up to 180 days. Therefore, check for any additional charges that the plan may cover.

Sub-limits

Typically, there are sub-limits to organ transplant coverage. From one insurance to another, it differs. Therefore, be careful to read the policy wordings or the policy brochure to understand the precise coverage benefits for an organ transplant. Purchase a plan that provides the most coverage possible for such challenging medical treatments.

Review the Claim Settlement Process

A smooth claim settlement process only eases tension when undergoing organ transplant. The faster you get the treatment, the higher are your chances of survival. So, if you rely on health insurance for organ transplant, which most do, ensure the claim settlement process is smooth with least steps. Check the claim settlement process of each insurer before choosing one. 

Look Closely at the Exclusions

Keep in mind that the donors' personal health insurance policies do not cover the costs of their hospitalisation. Therefore, it is crucial to understand admissible and inadmissible expenses, or exclusions, as well as sub-limits, because the insured receiver may be required to pay for such costs. With regard to the expense of the procedure for organ harvesting, the treatment costs for the organ donor are only partially reimbursed. The hospitalisation of the donor's other expenses is typically not reimbursed. 

Conclusion

Donor and transplantation insurance is a product whose demand is rapidly increasing, and more insurance companies are progressively realising this. As long as health insurance companies take note of the warning signs and meet this crucial niche need in insurance, we can soon witness a wave of very comprehensive insurance plans.

Read more -

• Do You Need a High-value Health Insurance Policy?
• 10 Ways You Can Select the Best Health Insurance Plan for Yourself