Work or Leave of Absence

Proceeding with a transplant will require you to be away from work for a period of time. A minimum expectation for an autologous transplant is six weeks, whereas the time off work for patients receiving an allogeneic transplant can range from three months to a year or more. Your transplant physician and coordinator will inform you about the time they would expect for you to be off work.

You will need to contact your employer’s Human Resources Department to ensure continuation of your employee benefits and to obtain information regarding medical leave and disability. If you are having difficulty understanding this information, please contact the Transplant Social Worker for assistance.

Insurance

Insurance Patients: Please note, your insurance is a contract between you, your employer and the insurance company. Our relationship is with you, not your insurance company.

It is important for you to read your plan’s benefits, and rules and regulations. We provide the service of a Transplant Financial Coordinator and Social Worker to assist you as needed, but it is ultimately your responsibility to understand your insurance policy.

Be sure to inform your Transplant Financial Coordinator of all health insurance policies you have and if you expect any changes in coverage during your transplant.

Patients covered under managed care plans (HMO/PPO/EPO’s) are responsible for complying with their insurance rules regarding referrals from primary care physicians to see specialists.

Failure to comply with your insurance requirements will make it necessary for us to bill you directly for charges incurred during a non-referred, non-covered visit.

We will file and process claims for insurance companies with whom we have contracts. Otherwise, payment is expected at time of service. Upon request, a copy of the bill will be furnished to you for insurance claim filing.

You are responsible for deductibles, co-insurances, and services or procedures not covered by your insurance company.

If at any time you or your spouse are eligible for COBRA coverage or are considering changing insurance providers please contact the Transplant Financial Coordinator prior to your selection.

Obtaining Insurance Approval for Transplant

A financial coordinator or your transplant coordinator will obtain information about your insurance coverage. Even if you are still deciding whether or not you want to have a transplant, it is a good idea to determine what insurance coverage you have for the procedure. Approval for payment of transplant expenses by your insurance company does not mean that you have to proceed with the transplant. Please do not confuse this initial review of benefits with “preauthorization” or final approval by your insurance company. Almost all insurance companies require a detailed review of your case by an insurance physician prior to actual approval for transplant and related services.

Preauthorization

Preauthorization by your insurance company means the company agrees that a transplant is medically necessary and the appropriate treatment for you. However, payment for your treatment is still based on your individual policy. You may be responsible for part of the payment or for related services. Our goal is to limit your out-of-pocket expenses as much as possible and to keep you informed about our interactions with your insurance company. (Personalized financial counseling is available for patients).

Denial

Do not be discouraged if your insurance company initially declines to cover the cost of your therapy; often they only need more specific information to understand why you are an appropriate candidate for this treatment. We will provide them with the necessary information and keep you informed of the process.

Out-of-Pocket Expenses

Insurance companies often limit the money they allocate for your treatment to specific services. This means that some things, including housing, dental exams, and outpatient prescriptions, may not be covered. We will do our best to let you know as soon as possible about any restrictions. However, it is your responsibility to understand the provisions and restrictions of your policy. The best way to get information regarding your policy is through your employer’s benefits or human resources personnel or by calling your insurance company’s customer service line. You will also be assigned a case manager by your insurance; this person will be a good resource for you once the insurance process begins.

Other Resources

You may be eligible for Social Security Disability and/or Supplemental Security Income. The Transplant Social Worker is available to help you with determining your eligibility for these programs and can assist you in filling out the necessary forms. You may also have disability coverage through your employer. There are some limited community resources that may be available - please contact the transplant social worker for more specific information or eligibility requirements.

Fundraising

If you find that some services related to your transplant are not covered by your insurance policy, you may want to do some fundraising to help cover your out-of-pocket costs. Your transplant coordinator and the transplant social worker are available to discuss this option with you and to assist in whatever way possible. However, check with your transplant financial coordinator to see if fundraising may interfere with your insurance coverage before you begin. 


A majority of your insurance/financial questions are best answered based on your specific insurance coverage. Please contact your designated Transplant Financial Coordinator for further assistance.

What is a deductible?

A set amount owed for health care services by the patient prior to the health insurance or plan begins to pay.

What does “Out of Pocket” limit mean?

This is the maximum patient financial responsibility within a plans benefit year. Some health insurance plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward the limit.

What does In-Network vs Out-of-Network mean?

In network means there is an established contract between the provider and insurance company and out of network suggests there are no contracts between the provider and insurance company.

In order to maximize the insurance coverage and minimize patient costs insurance companies recommend accessing In Network providers. Some health insurance plans may not cover out-of-network or increase the deductible and co-insurance limits.

What does 80/20 or 70/30 mean related to out-of-pocket costs to me?

Co-insurance assigned responsibilities. The first number indicates insurance responsibility and the second number is the patient’s financial responsibility. The co-insurance applies to the Out of Pocket.

What is Preauthorization?

A decision by the health insurance plan that a health care service, treatment plan, or transplant is medically necessary.

We have a dedicated team of Transplant Financial Coordinators that obtain the Transplant Consult, Transplant Evaluation, Donor Evaluation and Transplant event authorizations. All other service authorizations are usually obtained by the ordering physician practice.

The Transplant Finance Team with over 80 years of experience is dedicated to provide guidance and support to maximize the health insurance benefits of every patient. Our mission is serving humanity to honor God by providing exceptional and cost-effective health care, accessible to all.

***Please contact your assigned Transplant Financial Coordinator for any insurance benefit questions, concerns, or any changes of insurance coverage****

In order for us to provide you with excellent service. Please have your Insurance and Pharmacy Card readily available or submit to your assigned Transplant Financial Coordinator listed below.

Lety De La Zerda: Transplant Financial Coordinator Team Lead (Alpha A-G)
Phone: (210)575-7363; Fax: (210) 510.7029; Email: Leticia.Delazerda@mhshealth.com

  • Ten-year expertise as a Bone Marrow Transplant Financial Coordinator.
  • Three-year knowledge registering and Hospital financial counseling.
  • Six-year experience with assisting patients to obtain government assistance programs.

Maria Lungstrom: Transplant Financial Coordinator (Alpha H-R)
Phone: (210) 575-4776; Fax: (210) 510-6327; Email: Maria.Lungstrom@mhshealth.com

  • Five-year experience as a Transplant Financial Coordinator.
  • Five-year background billing for the Bone Marrow Transplant physicians.
  • Seven-year familiarity of insurance verification and billing with a private practice.

Cindy Pribyla: Transplant Financial Coordinator (Alpha S-R)
Phone: (210) 575-8082; Fax: (210) 510-7627; Email: Cynthia.Pribyla@mhshealth.com

  • Half a year experience as a Transplant Financial Coordinator
  • Over fifteen-year background in insurance verification and in obtaining authorizations for high cost procedures.

Christina Perdue: Global Billing Analyst
Phone: (210) 575-3798; Fax: (210) 510-6885; Email: Marisa.Perdue@mhshealth.com

  • Over a year experience billing for our Global Transplant patients.
  • Ten-year understanding of insurance payment collections and underpayments making certain that the insurance company reimburses providers accurately.
  • Four-year background with Health Information Management

Matias A Pelaez: Manager Transplant Finance
Phone: (210) 575-8533; Fax: (210) 510-6534; Email: Matias.Pelaez@mhshealth.com

  • Five-year experience with the Transplant Program as a Financial Coordinator, billing, and reimbursement analyst.
  • Two-year background assisting patients to obtain government assistance programs.
  • Five-year knowledge in domestic/International Insurance verification/authorization.