Does CarePlus have connections with transplant programs?

Yes. Our national transplant network includes facilities with transplant programs from which our members can receive transplant services. 

How do we select the facilities in our transplant network? 

We review programs based on a set of guidelines established by our Facility Selection Committee. 

What programs are in our national transplant network? 

To get a list of programs in our national transplant network, please call Servicios para afiliados to be directed to our transplant team.  

Will a CarePlus member who needs transplant services receive those services at the hospital closest to where they live?   

Not always. We will work with the member and their physician to select the program in our national transplant network that best fits their needs. To get a list of programs in our national transplant network, please call Servicios para afiliados to be directed to our transplant team. 

Who determines where within our national transplant network a CarePlus member will receive services? 

Our member and their physician(s) select the most appropriate facility. 

Does our national transplant network include facilities that provide pediatric services? 

To get a list of programs in our national transplant network, please call Servicios para afiliados to be directed to our transplant team.  

What types of transplants are performed at facilities in our national transplant network?  

Facilities in our national transplant network perform services for all covered solid organ transplants and stem cell transplants. 

Understanding your transplant benefits  

Transplant benefits are specific to a member's CarePlus health plan. To get information about transplant coverage, payment process, covered medications and travel, please call Servicios para afiliados to be directed to our transplant team.  

Reimbursement for travel and lodging costs related to a transplant  

CarePlus members may be eligible for reimbursement for travel and lodging expenses for services directly related to their transplant performed at the transplant center. Limitations and maximums may apply. CAR-T travel and lodging is not reimbursable by CarePlus.

The following scenarios are not all inclusive. To get information specific to your CarePlus plan and coverage, please call Servicios para afiliados Department to be directed to our transplant team.  

Travel and lodging reimbursement 

You must travel at least 100 miles one way to the transplant center where you will receive services. Reimbursement is limited to $10,000 per transplant, is available for expenses incurred by our member and up to one companion and is combined and applicable to the categorical capitation and $10,000 maximum.

Personal automobile travel 

Mileage incurred when driving a personal vehicle is reimbursed at a rate of $0.22/mile, which is inclusive of gasoline used when traveling to and from home, hospital/clinic and/or applicable hotel only. 

You or your companion must take the most direct route when traveling to and from home, hospital/clinic and/or applicable hotel. 

Tolls are reimbursable. Please keep receipts. 

Mileage for personal reasons is not reimbursable.   

You can submit mileage for only the use of one vehicle. 

Mileage is inclusive of all personal car expenditures. CarePlus will not provide additional reimbursement for gasoline, oil and/or other car-related expenses.

Mileage reimbursement information is subject to audit and possible denial, if mileage is deemed excessive. 

Rental car 

Rental car services used when traveling to and from home, hospital/clinic and/or applicable hotel only are reimbursable at a rate of up to $70 per day.  

Gas is reimbursable with receipts, but gas charges incurred at a rental car facility (such as if you return the car with less than a full tank and the rental car facility charges you to fill the tank) are not reimbursable. 

Mileage, additional insurance or other service upgrades for your rental car are not reimbursable. 

Bus and/or train tickets 

Coverage of up to $150 for our member receiving the transplant and up to one companion is available to reimburse for costs associated with bus and/or train round trip tickets. Please save receipts.

Train or bus upgrades are not reimbursable. 

Airplane tickets 

Coverage of up to $400 for our member receiving the transplant and up to one companion is available to reimburse for costs associated with the purchase of round-trip tickets. 

Tickets must be for lowest-cost economy class tickets. Reimbursable amount of up to $400 for our member receiving the transplant and up to one companion includes luggage and baggage fees.

Airline upgrades are not reimbursable.  

No incluye ambulancias aéreas ni jets privados. Si por motivos médicos se requiere una ambulancia aérea, pueden aplicarse otros beneficios.

Excluded when airline travel is required only because our member is at a more distant location than their primary residence, such as at a secondary temporary or permanent residence that is far enough way to warrant air travel. 

Uber, Lyft, taxi, subway and other forms of ground transportation 

Coverage of up to $25/day maximum for our member receiving the transplant and up to one companion is available to reimburse for costs associated with ground transportation costs. 

The lowest economical Uber or Lyft vehicle must be used, if using this form of ground transportation.  

Not reimbursable when personal car or rental car is used or for personal travel costs (e.g., travel to and from a restaurant) or for upgrades. 

Is reimbursable if our member flew from the city where they live to a different city to receive transplant services and needs ground transportation to get from airport to lodging, from lodging to hospital/clinic and then back to airport at a rate of up to $25/day. 

Estacionamiento

Coverage of up to $25/day maximum. 

When using a personal or rental, up to $25/day maximum for general parking at hospital/clinic is reimbursable if complimentary parking is not available and up to $25/day for hotel parking is reimbursable if complimentary parking is not available. 

Valet parking is not reimbursable and neither are costs for parking for personal reasons (e.g., parking other than at a hospital/clinic or hotel/lodging site). 

Lodging expenses 

Lodging costs of more than $150/day for our member receiving the transplant and up to one companion are subject to review and denial. 

Lodging is reimbursable during our member’s inpatient hospital stay for one companion and applies to the $10,000 maximum. 

Coverage includes nightly hotel charge and applicable state, city and local taxes and excludes: 

Resort fees 

All hotel upgrades 

All meals, food, drinks, snacks or other ancillary services or products 

Resort fees 

Valet parking or paid parking when the hotel offers complimentary parking 

Purchases from hotel gift shop or hotel stores 

Short-term housing rental costs are reimbursable and will apply to the $10,000 maximum 

El alojamiento en casa de familiares y amigos no califica como un gasto de alojamiento reembolsable.

Food and other personal items 

Unless otherwise stated in your health plan documents, all food, beverages, snacks and other personal items of all forms are not reimbursable. 

¿Qué es una evaluación para trasplante?

A transplant evaluation includes consultations, tests and X-rays ordered by the transplant program physicians for our member and potential donors before transplant services are performed. 

What type of help do transplant case managers provide? 

Transplant care managers help coordinate transplant needs, explain benefits and help with other transplant-related issues our members may have. Our transplant care managers are registered nurses. To contact our transplant care managers, please call Servicios para afiliados to be directed to our transplant team.  

Who do I call with my billing or claims question? 

For billing and claims questions, please call Servicios para afiliados to be directed to our transplant team.  

I have a question that isn’t listed here. 

To get answers to questions not addressed here, please call Servicios para afiliados to be directed to our transplant team.