Will Medicare pay for intestinal transplants?
Yes, Medicare does pay for intestinal transplants. They offer these transplants for disabled and elderly patients at three government-approved transplant centers. The change of the policy became effective on April 1, 2002.
According to Tommy G. Thompson, secretary of the United States Department of Health and Human Services claims that the decision is a big step in advancing patients’ access to proven new technologies and treatments.
Richard Coorsh, spokesperson for the Health Insurance Association of America, says, “It’s frequently the case that private insurers often follow the government’s lead when deciding which procedures they will cover.
However, in this case, it will have to be decided from carrier to carrier.” Patient advocates want for this decision to prompt private insurers to follow suit.
The small intestine is replaced in people whose digestive tracts cannot absorb nutrients during intestinal transplantation. A patient with total intestinal failure is only qualified for this type of surgery and he must also be deemed unable to tolerate “total parenteral nutrition” (TPN).
This procedure allows nutrients to be fed to the patient intravenously. According to health officials with the U.S. Health Care Financing Administration (HCFA), there are patients who can’t tolerate TPN because that process might cause them infection, blood-clotting, liver failure or other side-affects.
At least 10 intestinal transplants must be performed per year by hospitals that will have to make these transplants to Medicare beneficiaries who are eligible. Another requirement is that the hospital should have a one-year survival rate of 65 percent.
Mt. Sinai Hospital in New York, the University of Pittsburgh Medical Center in Pennsylvania, and the Jackson Memorial Hospital Transplant Center in Miami, Fla., are the hospitals that currently remain approved by HCFA in order to perform the operation.
According to the HCFA officials, the transplantation of intestines is a new technology and has been pioneered mainly at the University of Pittsburgh School of Medicine in this country. This operation has been performed fewer than 1,000 times. Two-thirds of the patients were children.
These operations haven’t been made often, and it is important to keep that in mind. Call your insurer and ask whether you are eligible for these transplants, if you need them. Not many insurers will offer such an operation, so don’t be surprised if you won’t be eligible.