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Are Organ Transplants Covered By Your Health Insurance Plan?
With the advance of humanity, medical science has kept pace – it can help extend our lifespan and protect us from deadly viruses. It has advanced so much that a malfunctioning human organ can now be replaced with a fully functional one. This is called organ transplantation. Thanks to medical science, the number of deaths that were attributed to organ failure have reduced, and lots of lives have been saved. In 2019 alone, India saw more than 12000 organ transplants.
However, organ transplantation can be super expensive.Apart from the standard complications in harvesting and screening the organ, there are two surgeries required - one for the patient and the other for the donor. Next comes the hospital stay and follow-up procedures. The overall costs can mount upto lakhs.
At private hospitals in India, cornea transplants cost within Rs. 50,000 to Rs 1 Lakh, heart transplants range between Rs. 10 Lakhs and Rs. 16 Lakhs, and liver transplants can be as expensive as Rs. 25 Lakhs to Rs. 30 Lakhs.
We know the costs sound overwhelming, but there’s a silver lining - your Health Insurance Policy. Yes, it may take the load off.
In this article, we’ll go step-by-step and decode the type of expenses involved, and map it with the coverage available. Let’s start with the basics.
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List Of Conditions For Organ Donation
You may require an organ transplant because of a serious illness or injury - where the organ is impaired and a replacement is advised. A doctor may suggest an organ transplant in cases of
Kidney failure
ver damage
Heart disease
Damage to cornea
Lung disease
Dysfunctioning of heart valves
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Expenses Involved In An Organ Transplantation
For both the donor and the recipient, there are mainly 6 medical expenses involved.
Type of expense Description Organ screening To check the overall compatibility, and to see if blood groups of the donor and the receiver match. Pre-hospitalization Once the organ donor has been finalised, the person undergoing the transplantation (organ recipient) must be brought to an accurate medical condition - by the use of some medication. Hospitalisation Includes the hospital room rent, doctor’s charges, and nursing expenses. Cost of surgery Includes the transplant costs and surgeon fees. Post-hospitalization Post surgery, the recipient and donor are monitored and their conditions tracked. This entails the cost of follow-ups with the doctor, medication, tests, among others. Post-surgery complications Includes hospitalisation and treatment because of complications that may arise due to the transplant. -
Expenses Covered Under Health Insurance
It is important to note that insurance companies will not cover all the expenses incurred by the organ donor. There are some exclusions and the organ recipient may have to bear these costs.
The table below portrays both the inclusions and exclusions.
Type of expense Organ Receiver’s Expenses Organ Donor’s Expenses Organ screening Covered Not Covered Pre-hospitalization Covered Not Covered Hospitalisation Covered Covered under organ receiver’s policy Cost of surgery Covered Covered under organ receiver’s policy Post-hospitalization Covered Not Covered Post-surgery complications Covered Very rarely covered -
Things The Organ Receiver Should Keep In Mind
There are some strict guidelines when it comes to organ transplants. Hence, the organ donor should comply with the Transplantation of Human Organs Act, 1994, and declare that the organ donated is for personal health purpose only.
A lot of expenses that the organ donor will incur are not covered and the organ receiver may have to bear them. It is, thus, important to understand the exclusions and limitations. Ask the hospital for a detailed breakdown of the expenses for both donor and receiver.
Ask the hospital for a detailed break-up of expenses - for both donor and receiver - before the surgery.
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Things The Organ Donor Should Keep In Mind
If you want to buy a new health insurance policy and are an organ donor already, then it is at the discretion of the insurer whether to cover you or not. Some insurers may consider you a high-risk case and decide not to sell you a plan.
If you are an organ donor and already have a mediclaim policy, the insurer cannot deny your policy renewal.
If you had donated an organ before buying a health insurance policy, but while purchasing it, did not declare that to the insurer - the insurer can rightfully deny renewal. This is because you withheld an important piece of information. So always be transparent and honest with your insurer, and they will try to give their best to you.
Let’s Take A Look At An Example.
Mr. Verma suffered from chronic renal failure and was advised to undergo a kidney transplant surgery. After waiting for some time, he was lucky enough to find the right donor. The kidney transplant went successfully, and now was the time to file the health insurance claim.
The overall cost of the kidney transplant in a private hospital was around Rs. 55,00,000 - which Mr. Verma paid and then filed a claim for reimbursement.
As the following conditions were met, the insurer approved the claim for kidney transplant - under Mr. Verma’s Health Insurance Policy -
The original claim for Mr. Verma’s condition - renal failure - was approved.
Organ donation was in accordance with the Transplantation of Human Organs Act, 1994.
The transplant took place under the medical advice of a verified medical practitioner.
The claim of Rs. 55,00,000 was partially admissible, because the insurer rejected the cost of medical screening and pre and post-hospitalizations of the donor - under the policy exclusions. However, a significant part of the transplant expense - Rs. 35,00,000 - was taken care of under Mr. Verma’s health insurance, hugely reducing his financial burden.
Not all superheroes wear capes, some donate their organs and save lives. If you are one of those superheroes, we celebrate you with our whole heart. And if you are an organ recipient, we hope things go well and you heal faster. Remember to choose a good health insurance policy, and protect yourself and the donor from financial trouble.
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Sharing the experience of happy and satisfied customers with you.
Sameer Yadav
I was searching for investment plan but I couldn't find it, then I got the call from SMC insurance and they aligned a call with Ishita Sharma as point of contact (POC) for all my queries and she explain me very well. Ishita explain me all investment plan with advantage and disadvantage, I really appreciate her. Ishita always enthusiast towords work and ready to answer all my questions .I have taken two policies ( HDFC click to invest) plan with 15k premium per month. I always recommend SMC insurance to all, for better life and happy retirement with huge health and wealth. Thank You SMC insurance for your best service. Special thanks to Ishita for E2E help and endless support, you did fabulous work. Show More
Dheeraj Bhatia
I am associated with SMC insurance since 2011 and found them to be most ethical, trustworthy and highly responsive. Some of my precious policies done thru other agencies are still running on SMC’s advice. That is a strong testimony to their customer-centric approach. I am glad to be associated with SMC and strongly recommend their services to all concerned. Wishing the very best to Team SMC !Show More
Jyoti Sharma
We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial. One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill. Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More
Sumit Khanna
Hi, I am Sumit here, purchasing insurance policies from SMC for almost 8 years. Would like to recommend this company to other customers because they are taking care of my insurance broking services in a fabulous way. I would like to extend my gratitude and thanks to policy servicing and also insurance claim backend services. They have rendered fantabulous services for me and would like you guys to definitely go and rely on them for all your insurance needs.Show More
Kishor Kumar Bijlani
My experience with SMC Brokers is excellent. They provide support from the beginning till end i.e from issuance of insurance policies till settlement of claims. They explain very nicely various provisions relating to Insurance Policy also facilitate settlement of claims with Insurance Companies. Show More
Megha Singhal
I have purchased HDFC policy from SMC Insurance with the help of Harsh Sharma. I have got the satisfactory services from SMC Insurance. Thank you SMC Insurance.Show More
