Health Insurance For Heart Transplant

| June 27, 2011 | 0 Comments

Health insurance and the future of Medicare are in the news and on the table.  For persons considering the possibility of a transplant for any organ but especially the heart, understanding your health insurance choices and mapping out a health insurance strategy are very important considerations.

Not only will the transplant recipient want to know exactly what to expect in terms of procedural coverage but also have a complete understanding of all prescription coverage.  I am blessed to have coverage through a local, non-profit organization called the Capital District Physician’s Health Plan (CDPHP).  To me, the way this health insurance provider does business has no resemblance to the war stories that abound about the industry.

 

Throughout my long and frustrating wait list experience, CDPHP was there for me, not just as an insurance company but also as an adviser through their coaching system.  I have had two CDPHP coordinators.  When the first coordinator moved to a different position, I was nervous about the change.  But, the change was seamless.  I had a coach that really knew her stuff.  Not only that, but the coaches seemed interested in how I was progressing. 

For every question and for every new development, they either had answers or dug up answers and always returned calls.  No matter how you see it, it is a lot easier to work with an insurance provider that is proactive than work against one who is disinterested.  In many ways, I feel CDPHP went the extra mile to make sure that my case had direction and stayed on track. 

Once the patient decides to enter a transplant program, the patient must understand there are many factors that transplant centers consider.  Some centers, like Tampa General, have dedicated personnel to help potential transplant patients weave through the insurance process.

Most transplant centers will describe their health insurance protocol in their pre-transplant booklet.  A review of current coverage will be conducted during the pre-wait list interview and testing program. 

Heart transplant wait list patients will receive a list of typical medications used by patients on the wait list and after the transplant.  Those lists can be overwhelming and daunting.  If you carefully study these medications, you are likely to wonder why these are so important.  Sometimes the labels and warnings seem riskier than the exposure. 

Wait list medications are to protect your heart and body while you wait for transplant.  It is likely that you have heard many of the names and quite possibly heard all the potential side effects of these medications.  For me, there were certain medications that were hard to tolerate. 

Coumadin was added to my wait list medications after being on the list for a while.  The blood thinner can be difficult to tolerate and is likely to change your already altered diet.  In my case, the cardiologist took salads with lettuce off the table.  Because of its blood thinning abilities, every time I had even the most minor procedure, I was taken off Coumadin and instructed to use Lovenox, which is a blood thinner injected into the abdomen.

Coreg, Lipitor, Viagra and Lasix were just some of the medicines used to keep me stable.  My experience with Coreg was excellent.  Lasix also gave me relief.  For a while, I was taking 180 mgs per day.  The amount fluctuated according to the buildup of liquids in my body.  This buildup of liquids made it difficult to breathe.  I spent a lot of time urinating, but it was worth it.  The problem, of course, is that lasix can cause damage to the kidneys.  It is a perfect Catch 22.

There were several other wait list medications. The point is that if you are waiting for a transplant, you must have a sensible prescription insurance plan.  While you are studying your wait list medications, the transplant center will also provide a list of what medicines you can expect to use after surgery.  That list will make your wait list medications look like child’s play.

 

The quantities of medications will change as your recovery progresses but in the immediate post surgery period, the amount of steroids, immunosuppressive drugs and insulin injections is just plain intimidating.  Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system.

When your new heart is in place, your body wants to reject it.  All the immunal systems that have helped you through your life now turn against this new organ.  Just about every post transplant medication is designed to neutralize this natural rejection.  The problem is that these medications are potent and very likely to cause other, serious damage to organs.  You cannot live with them and you cannot live without them.  In fact, many of those medications may become lifelong medications.

When contemplating transplantation, be prepared for change.  Regardless of your condition, the post transplant “new you” will emerge.  The success of these medications and the cardioligist who is monitoring your case will shape the “new you.”

I was not a diabetic before my transplant and it looks like I may not be a diabetic much longer.  Due to the often overwhelming amount of steroids ingested, most tranplant patients are diabetic.  Again, some transplant recipients will remain diabetics the rest of their life.  For others, the need for insulin coverage will diminish as the amount of steroids decreases and the amount of exercise increases.  Of course, you will be turning away those sweet desserts and goodies with a high sugar count.  Yes, it hurts, but like abstaining from alcohol, your ability to eat right pays big dividends.  I now understand that you are what you consume.  Welcome to the new you.

So, now you understand the importance of proper prescription insurance.  A year and a half after my transplant, I still take about 20 different medicines per day.  In Albany, Rite Aide loves me.  In Tampa, it is Walgreens.  In fact, Walgreens delivers to my door.  Walgreens has a transplant coordinator who did everything from help me setup the medfication box to explaining what medications should be taken at different times than other medications.  The Walgreens in Tampa was extraordinarily professional.

However, despite all the bad news about health inusrance providers, my provider was my partner and coach.  Without that coverage, I honetsly do not know how I would have afforded the medications, much lesss the surgery.

The point of this article is that wait listers and transplant recipients need to build a relationship with their carrier.  Like some of the medications, this realtionship will last the rerst of your life.  Understand all available coverage and be an informed patient. Being an informed tansplant reicipient can yield a “new you” lifetime of dividends.

    

 

 

 

 

          

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