It was a hot Fourth of July less than a year ago when Ryan Stoy got the most important call of his 22 years: a signal from his mother, Ruth, to head for the airport. Twenty minutes away, a private jet was being fueled for him on an Indiana runway. In Manhattan, a team of surgeons was preparing for his arrival, and his parents were hurrying from their home in Pennsylvania to meet him there.
Before the fireworks had died out that evening, Ryan was in surgery at Columbia-Presbyterian Medical Center, receiving a new heart, a new pair of lungs - and a new chance at life.The dash to the operating table that day depended on split-second timing, but it was the culmination of years of effort on his parents' part - not only to reverse his worsening congenital heart disease but also to address the staggering medical expenses that transplant surgery involves.
About 20,000 people a year receive a major organ transplant, and each of those miracles costs big money: more than $300,000 for a new liver, for instance, and $200,000 in the first year for a bone-marrow transplant. Ryan's surgery ran up bills of more than $400,000, a mountain of charges that his father, Daniel, calls "overwhelming."
For any transplant candidate, the first issue is the prognosis: Will a new organ work? But close behind the questions of life and death are those of dollars and cents.
If a patient can't show that insurance or some other source will pay the minimum required by a transplant program, he or she probably won't be accepted for surgery.
"A hospital is not obligated to go broke," Dr. Frank Stuart, head of transplants at Northwestern Memorial Hospital in Chicago, says. "The point is, there's no free lunch."
For some patients, though, there might be something close. People who have been on Social Security disability for at least two years and those with end-stage kidney disease qualify for Medicare, which pays an approved rate for kidney, heart, lung, heart-lung, liver and some bone-marrow transplants. Medicaid covers transplants for low-income patients in some states.
Most employer group plans follow the lead of Medicare, says Joe Kirby of the Washington (D.C.) Hospital Center, contributor to the booklet "What Every Patient Needs to Know" (United Network for Organ Sharing; 1-888-894-6361, or www.unos.org).
There are ways to get financial help, even if insurance won't cover the whole tab:
- EMPLOYERS. People with employer-sponsored plans can ask their benefits manager to intervene. Companies that fund their own insurance plans (as most do) call the shots on benefits, and others may persuade an insurer to cover unusual expenses. An employer whose plan is self-funded may also agree to raise the lifetime maximum on benefits.
- FINANCIAL ADVOCATES. The financial coordinator at the transplant center where the surgery will be performed is a valuable ally who can advise patients on government programs, disability coverage, high-risk insurance pools and other aid.
- BARGAINING. The Stoys persuaded their health insurer to cover all of Ryan's surgery bills before approaching Columbia-Presbyterian. In some cases, the hospital may do the arranging, either asking the insurer to cover a patient at network rates or agreeing to waive co-payments.
- GROUP EFFORTS. Several services, including AirLifeline (1-800-446-1231), offer transportation between home and hospital for patients who can't afford it. Other groups provide grants, information on discounted accommodations and additional support. They include the National Transplant Assistance Fund (or NTAF, 1-800-642-8399), the Transplant Foundation (804-285-5115), the American Liver Foundation (1-800-223-0179) and the American Kidney Fund (1-800-638-8299).
- DRUG COMPANIES. Pharmaceutical firms often have their own assistance programs, which are not necessarily limited to indigent people.
Sometimes families explore all those possibilities and still fall short. Then the solution is both obvious and difficult: asking friends, relatives, co-workers and community to help out.
"It's a very humbling experience," says Daniel Stoy, Ryan's father, but it can reap mighty re-wards.
The Stoys' church raised $28,000 through a baked-potato bar and a "raise and praise" service of singing and basket-passing. Daniel Stoy's employer helped put together a golf tournament that brought in $22,000.
Mennonite Mutual Aid, an insurance arm of the church, matched donations, as did the employer. And a friend arranged for Ryan's private-jet ride at cost. The result of all that generosity: more than $100,000.