Bone Marrow and Organ Transplants

Bone marrow and organ transplants are covered when established criteria for medical necessity are met. Covered organ transplants may include, but are not limited to cornea, heart, heart-lung, kidney, liver, lung, pancreas, pancreas-kidney and bone marrow transplants, depending on the member’s benefit plan.

All requests for organ transplants, except corneal transplants, require pre-authorization prior to any referral. Pre-authorize bone marrow or organ transplant services with ConnectiCare as soon as the patient’s needs are known, prior to any evaluative services.

Services are available at participating facilities, including contracted Centers Of Excellence. To obtain a listing of participating transplant facilities, call (860) 674-5860 or 1-800-562-6833. Exception: Members covered under a ConnectiCare of Massachusetts, Inc. or ConnectiCare of New York, Inc. plan may have access to out-of-network facilities.

Request services in writing from ConnectiCare’s Medical Operations Department by FAXing us at:

(860) 674-5893 or 1-800-923-2852

What happens next?

• The case manager will request clinical documentation. Upon receipt, the case manager will review the documentation with ConnectiCare’s medical director to determine medical necessity and benefit coverage. • The case manager or medical director may discuss the determination with you by phone and will follow up with a written determination.