Our financial coordinator is responsible for assisting you with the hospital bill process; however, if you would like assistance with other bills, they can help. They will meet with you at your evaluation appointment and will:
- Discuss your insurance benefits with you
- Discuss any financial concerns you may have
- Explain co-payments, out-of-pocket amounts, deductibles, coinsurance, and fee schedules
If our financial coordinator determines your insurance has inadequate coverage for you during this process, we will work with you to try to obtain additional coverage.
We suggest that you start a filing system for all your bills. Start by coordinating your bills with your insurance company’s explanation of benefits. This will show you what was billed, what your insurance company paid, and if any balance is due by you.
Our financial coordinator will assist you with any financial concerns about your bone marrow transplant. They will financially accept you for your bone marrow transplant admission and other related services and can be reached Monday through Friday from 8:30 a.m. to 5 p.m at (585) 275-6021.
Clinical documentation is sent to your insurance company, where a medical director will review your information and determine whether you fit their criteria for a bone marrow transplant, according to your insurance contract rules and regulations. Generally, the insurance company notifies us about approval within two weeks. Then, our financial coordinator notifies the transplant team of the insurance company’s response.
Billing Information for Donor Testing
If there is any donor testing done as part of the transplantation, the patient (recipient) is financially responsible for any fees.
If sibling testing is done, we ask the donor for his or her insurance information so we can follow the coordination of benefit rule, which states that the donor’s insurance is billed first if there is donor coverage on his or her insurance plan. If there is no donor coverage on the donor’s plan, we then bill the patient’s insurance.
If a donor search is requested through the National Marrow Donor Program, there is an activation charge of $600 that is not covered by insurance companies. Once the search is activated, each donor that is a potential match has additional testing done at our request, generating additional charges. We generally call upon three to six donors at a time, to keep charges down as much as possible. The charge for each donor is approximately $350 to begin the process, and additional charges are incurred depending on the type of testing. There are many different factors in this process, so it is difficult to determine the actual cost. However, most patient’s insurance companies cover the charges for the donor.
Pharmacy coverage can be an issue because of the high cost of some medications, such as neupogen and epogen (growth factors). Your insurance plan may have specific requirements, such as restraints to purchase medications at a participating pharmacy or prior authorization for certain medications. The financial coordinators will review this during your evaluation, so that they can determine your needs upon discharge, as well as limit your out-of-pocket expenses.