UnitedHealthcare says it will start reimbursing kidney donors for their travel expenses in hopes of boosting donation rates that otherwise have been falling off.
Kidneys donated from living donors provide recipients with better odds than organs from a deceased donor, doctors say, but living donors often face financial barriers that prevent them from giving.
The program from Minnetonka-based UnitedHealthcare starts next year, and will cover up to $5,000 in travel and lodging costs for donors who are giving a kidney to a recipient with UnitedHealthcare insurance.
The program could pay for itself because a kidney transplant can help avoid the expense of dialysis treatments and hospital visits that can cost up to $250,000 in a year, said Dr. Jon Friedman, a chief medical officer with the Optum division of parent company UnitedHealth Group. A kidney transplant and a year of follow-up care, meanwhile, cost about $150,000 or less, he said.
“It’s a financial win for insurance companies, but not all insurance companies have figured that out,” said Dr. James Allan, president of the American Society of Transplantation and a surgeon at Massachusetts General Hospital.
“And it’s the right thing to do for a patient,” Allan said. “So, it’s one of these special occasions where the cost-effective thing is actually medically the best thing, and ethically the best thing.”
The waitlist for kidney transplants contains more than 100,000 people, according to the National Kidney Foundation. Last year, more than 4,000 patients died waiting.
In 2015, nearly 18,000 kidney transplants were performed in the U.S., the foundation says, with one-third made possible by living donors. The group says it supports proposed federal legislation that would prohibit insurance companies from denying, limiting or charging higher premiums for life, disability and long-term-care insurance to living donors.
Another financial barrier is lost wages, according to transplant surgeons writing in a medical journal this year. They called for action on policies to eliminate unreimbursed out-of-pocket costs for living donors.
Transplants are performed at regional centers that might be 100 miles or more from the home of a potential donor, said Allan of the American Society of Transplantation.
Donors typically make several trips because there are several evaluations before a surgery, plus follow-up care later, Allan said. The visits also involve hotel stays.
“If you’re going to do something great for someone, and then you find out it’s going to cost you $1,000 on top of that and you don’t have any disposable income, it’s a significant burden,” he said.
Professional groups for transplant surgeons came to United with the idea for the program, said Friedman, the Optum official.
Those groups have data suggesting that 96 percent of living donors see a financial impact from giving, with nearly 80 percent saying they would benefit from some reimbursement for travel.
It’s not clear exactly how many more people would agree to become living donors if travel costs are reimbursed, but Friedman said his company is hoping for another 8 to 15 living donor transplants next year.
The program applies to the roughly 5 million people in United’s “fully insured” products. Currently, that population sees about 75 living donor transplants per year.
If it goes well, the program could be expanded to United’s other customer groups, Friedman said. He said United also hopes other health insurers will follow its lead, since not many currently cover travel costs.
A donor’s medical costs currently are covered by the recipient’s health insurer, Friedman said. With the new program, United will also cover travel and lodging costs from the beginning of the donor’s medical evaluation through a two-year period after the transplant. Travel costs for a companion would be covered, too.
Donors don’t need to be enrolled in a UnitedHealthcare plan to qualify for reimbursements, although recipients would be covered by the insurer.
Living kidney donation peaked in 2008, roughly the time the national economy stalled, Friedman said. The correlation is another reason to think there’s a connection between financial barriers and the supply of living donors, he said.
“Over the last five years, living donation has dropped,” Friedman said. “We need to flip the slope of the curve.”