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201610287

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UWHC,UWMF,

Policies,Administrative,UW Health Administrative,Fiscal Affairs

Financial Screening for Solid Organ Transplant (2.26)

Financial Screening for Solid Organ Transplant (2.26) - Policies, Administrative, UW Health Administrative, Fiscal Affairs

2.26

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Administrative (Non-Clinical) Policy

This administrative policy applies to the operations and staff of the University of Wisconsin Hospitals and
Clinics Authority (UWHCA) as integrated effective July 1, 2015, including the legacy operations and
staff of University of Wisconsin Hospital and Clinics (UWHC) and University of Wisconsin Medical
Foundation (UWMF).
Policy Title: Financial Screening for Solid Organ Transplant
Policy Number: 2.26
Effective Date: October 1, 2016
Chapter: Fiscal Affairs
Version: Revision
I. PURPOSE
To articulate the procedure for financial screening for potential transplant patients.
II. POLICY ELEMENTS
For scheduled/non-emergent patients, UW Health requires confirmation of ability to pay, either through
verified insurance coverage, eligibility for government programs or personal payment, for all potential
transplant candidates prior to listing a patient for transplant. Partial charity care consideration may be
given with regard to transplant services (refer to UW Health Financial Assistance Policy) because both
the cost of the initial transplant procedure and the ongoing cost of post-transplant care would exceed the
finite resources of UW Health and would limit our ability to provide charity care to other patients.
III. PROCEDURE
Scheduled/Non-emergent patients
A. All patients requesting a transplant evaluation will be referred to a Transplant Financial
Counselor prior to the scheduling of an appointment for evaluation.
B. All registration information is collected and documented in Health Link.
C. Insurance coverage, if present, will be confirmed and benefits specific to outpatient, inpatient and
pharmacy services determined and documented. This will include benefit maximums and other
limitations.
D. Where insurance coverage is not present, the patient will be screened for eligibility for
government programs or other programs that may provide coverage for the care. Assistance in
submitting an application will be provided by Transplant Financial Counselors and Government
Programs Coordinators.
E. Where no coverage for the transplant and post-transplant care is available, a financial statement
from the patient will be obtained to assess the patient's ability to pay for the care.
F. The Transplant Financial Counselors will provide a price estimate for the first year's transplant
related services, including pre and post-transplant care and pharmaceuticals prior to the first
appointment. Uninsured patients with insufficient financial means to pay for their pre and post-
transplant care will not be granted an appointment for transplant evaluation or listed for transplant
at UW Health. An uninsured individual with means to pay for the transplant will be required to

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complete the Self Pay Agreement of Financial Responsibility document and provide a verification
letter from a financial institution confirming funds dedicated for transplant only.

Unscheduled/Emergent patients

A. Insurance coverage, if present, will be confirmed and benefits specific to outpatient, inpatient and
pharmacy services determined and documented. This will include benefit maximums and other
limitations.
B. Where insurance coverage is not present, the patient will be screened for eligibility for
government programs or other programs that may provide coverage for the care. Assistance with
the application will be provided by Transplant Financial Counselors and Government Programs
Coordinators.
C. Where no coverage for the transplant and post-transplant is available, a financial statement from
the patient/family will be obtained to assess the patient's ability to pay for the transplant.
D. Uninsured patients with insufficient financial means to pay for pre and post care will not be
considered for transplant.
E. When confirmation of insurance coverage or government program eligibility is not yet
determined, the Access Services and Transplant Service Line Directors will discuss the patient’s
current financial and clinical situation including payer’s patient sobriety requirements and
unstable insurance coverage. The Transplant Service Line Director will then update the
physicians who will ultimately decide if the patient should be listed without financial clearance.
Listing will not occur until the Transplant Financial Counselor and the Transplant Coordinator
inform the patient/family of the potential financial risks of moving forward.
F. This same process (E.) is followed for Destination LVADs, except the Heart, Vascular and
Thoracic Service Line Director (not the Transplant Service Line Director) communicates with
the Access Services Director and the physicians. Implant will not occur until the Transplant
Financial Counselor and the LVAD Coordinator inform the patient/family of the potential
financial risks of moving forward.

VI. COORDINATION
Sr. Management Sponsor: SVP, Chief Financial Officer
Author: VP, Revenue Cycle
Reviewer: Director, Access Services

Approval committee: UW Health Administrative Policy and Procedure Committee

SIGNED BY

Elizabeth Bolt
UW Health Chief Administrative Officer

Revision Detail

Previous revision: 062013
Next revision: 102019