For those that have experienced an organ transplant either as a patient or loved one, you know firsthand the emotional roller coaster this can be – from the onset of being diagnosed to a recipient. While most patients can be candidates, in some cases difficult medical decisions are made due to age, lifestyle, comorbidities, and other possible considerations.
For some of us, due to COVID, lung transplants are a reality we have or must face. According to NPR and data obtained from the United Network of Organ Sharing (UNOS), about one in 10 lung transplants in the United States now go to COVID-19 patients. This trend is alarming for several reasons:
- UNOS’s data reflects the early impacts of COVID, but not what may transpire in the future. Some physicians anticipate the number of lung transplants relating to COVID are understated and will likely increase in the future.
- This will add financial pressures to patients, employers, and insurance companies in an environment where costs are already high and outpacing inflation.
- Lastly, the medical community will have the unfortunate and very difficult burden of deciding which patients are best qualified for a lung transplant and advising the patient and loves ones fortunate to receive such a gift of the patients’ average lifespan after the procedure.
As an insurance mechanism, USBenefits Insurance Services, LLC (USB) primary objective is to mitigate an employer’s financial stress by managing for the best possible claims outcome. Often, we become the second set of eyes for our Third-Party Administrators (TPA) and Producers, as well as an important resource due to our legal, medical, and cost containment partners, who are all aligned with the same objective – the best claims outcome for the employer.
With respects to organ transplants, USB works closely with our Producers and TPAs in considering several options as part of the employer’s stop loss program design:
- During an employer’s renewal process, if a plan member is identified as a potential organ transplant recipient, the stop loss carrier, in concert with the Producer and/or TPA, may laser the individual in question – that is, offer a higher deductible to the individual as compared to the standard specific deductible on the policy.
- While it’s often difficult to anticipate if any organ transplants may occur during an employer’s policy period, a good risk management practice is to consider is whether an organ transplant policy should be purchased. As a consideration, the stop loss carrier may provide a rate discount as the financial liability is being transferred to another party.
- There are unfortunate circumstances, such as an unanticipated organ transplant during a policy period while there’s no organ transplant policy in place. Therefore, it’s vital that your stop loss carrier has executed contracts with firms that have network agreements to address these situations. Having the right partners, regardless of the nature and size of a claim, is critical for the best outcome. Equally as important, a Producer or TPA should be able to call upon their stop loss carrier for assistance to carry the ball, especially when it’s understood that the cost will exceed the specific deductible from the onset of the claim. Such relationships and coordination often lead to favorable outcomes.
Contact USB to find out how we can partner with you, as well as to hear about our recent Claims success stories.