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¶ … Coin: Heads
Insurance options available to the patient depend upon the policy held by the patient and what is covered by the insurer. Some insurance companies will cover life-saving operations, while others will not (Roizen, 2015). Yet even if the operation is covered, there may be a substantial deductible that will have to paid out of pocket; again, this all depends on the type of insurance coverage that the individual possesses. In a time like this, it is difficult to think of finances especially when a loved one's life is at stake. Fortunately, even if the deductible is high, or -- in a worst case scenario -- the insurance company will not cover the operation, there are hospitals that will provide financial aid to applicants.
At the same time, government insurance options are available, such as Medicare and Medicaid. If the patient is 65 years of age or older, he may already be eligible for Medicare, which is a federally funded program to assist persons in old age with medical bills. Medicaid is funded by both state and federal governments and is available for low income families whose household earnings are under a projected threshold. In a family of 4, that threshold is currently around...
If the patient fits into either of these categories, they are measures that are worth exploring. If not, the previous possibilities of having coverage or of applying for financial aid through the hospital may be pursued. In many cases, hospitals such as Mercy Health offer financial assistance to individuals even if they have insurance coverage but still need help meeting the deductible. In any case, there are options available for this patient.
The main problem that the patient is likely to experience, however, is that the procedure recommended by the doctor is most typically going to be perceived as an experimental procedure that has not been sufficiently or adequately tested over time in order to meet the criteria for insurance coverage. Insurance companies usually will not choose to cover a life-saving procedure that has only been written about in an academic journal and not been time-honored and proven success over a series of clinical trials and become standard practice or medicine within the medical community (Williams, 2016).
With the cost of premiums set to go up around the country, due to the losses sustained by participating insurance brokerages in the Affordable Care Act, deductibles are most likely to rise as well, as insurance companies seek to make up for the lost ground in recent years (Durden, 2016). This will present further complications for families and will be another issue to consider, should the patient decide that seeking coverage may be the best option, if none is currently possessed by the patient.
Thus, the family's next steps…
References
Durden, T. (2016). Obamacare update: Insurance premiums set to explode higher in
2017. ZeroHedge. Retrieved from http://www.zerohedge.com/news/2016-05-09/obamacare-update-insurance-premiums-set-explode-higher-2017
Roizen, M. (2015). Will my insurance cover my liver transplant cost? Sharecare.
Retrieved from https://www.sharecare.com/health/digestive-health/transplant-cost-liver-insurance
Retrieved from http://abcnews.go.com/WNT/story?id=131212&page=1
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