Sidecar Health vs. PPO: the true cost of a liver transplant
Living with chronic liver disease can be a long and exhausting journey — filled with countless appointments, medications, and lifestyle changes to keep symptoms under control. But when the disease progresses to the point where a liver transplant becomes the only option, patients face another harsh reality: the financial cost of survival.
Let’s walk through one patient’s experience — a liver transplant needed due to chronic liver disease — and see how it compares under two different health plans: a traditional PPO and Sidecar Health.
Scenario
Event: A patient with chronic liver disease requires a liver transplant.
Hospital: In-network facility (for the PPO plan; Sidecar Health has no networks and members always have an option at or below the plan’s allowed amount).
Procedure costs:
- Pre-transplant and donor procurement: $50,000
- Liver transplant surgery: $250,000
- Hospital stay and post-op care: $240,000
- Medications: $45,000
- Total: $585,000
The traditional PPO experience
On a typical PPO plan, here’s what the financial picture would look like:
- Deductible: $4,000
- Coinsurance: 20% (in-network) / 40% (out-of-network)
- Out-of-pocket max: $8,000
- Specialty Rx deductible: $500
- Specialty Rx coinsurance: 25% (does not count toward OOP max)
- Specialty Rx out-of-pocket max: $4,000
Even though the hospital and surgeon are subject to the deductible and 20% coinsurance, the specialty medications are not — a common and frustrating surprise. That means a separate deductible and higher coinsurance applies.
Hospital & provider charges
| Service | Billed | Allowed (negotiated) | What member pays |
| Pre-transplant evaluation and donor procurement | $60,000 | $50,000 | $4,000 deductible + 20% coinsurance = $8,000 (OOP max) |
| Liver transplant surgery | $325,000 | $250,000 | Included in OOP max |
| Hospital stay & post-op care | $300,000 | $240,000 | Included in OOP max |
| Medications | $60,000 | $45,000 | $500 (Specialty Rx deductible) + $3,500 (specialty Rx coinsurance) |
| Total | $745,000 | $585,000 | $4,000 (deductible) + $4,000 (coinsurance) + $500 (Rx deductible) + $3,500 (Rx coinsurance) = $12,000 total |
The reality:
Even though the patient hit their in-network maximum, the specialty medications triggered a second deductible and higher coinsurance. Result: $12,000 out-of-pocket, for life-saving care.
The Sidecar Health experience
Sidecar Health is built to eliminate exactly these kinds of surprises.
Because there are no separate deductibles and no coinsurance, members don’t have to worry about confusing or unexpected costs.
With Sidecar Health, every service has a clearly defined Benefit Amount (the amount Sidecar Health pays), and for surgeries and other complex care, Sidecar Health’s care search assistance team helps members coordinate care with providers whose prices are at or below those Benefit Amounts, so they never owe more than their deductible.
In this example, the member’s care search assistance team guided them through every step — from selecting a transplant center to confirming that the surgical team would charge at or below Sidecar Health’s Benefit Amount. That coordination ensured the member would owe nothing beyond their deductible.
Hospital & provider charges
| Service | Cost | What member pays |
| Pre-transplant evaluation and donor procurement | $50,000 | $4,000 deductible |
| Liver Transplant Surgery | $250,000 | $0 |
| Hospital Stay & Post-Op Care | $240,000 | $0 |
| Medications | $45,000 | $0 |
| Total | $585,000 | $4,000 (deductible only) |
The difference:
Because Sidecar Health’s Benefit Amounts were sufficient to cover the total cost charged by the provider — and because the care search assistance team coordinated the surgery with high-value providers — the member would only pay their deductible. No networks to navigate. No balance billing. No financial shock.
Member costs side-by-side comparison
| Traditional PPO | Sidecar Health | |
| Deductibles | $4,000 | $4,000 |
| Coinsurance | $4,000 | $0 |
| Specialty Rx deductible | $500 | $0 |
| Specialty Rx coinsurance | $3,500 | $0 |
| Balance billing risk | High | None |
| Network restrictions | Yes | None |
| Cost visibility | Limited | Full — with transparent Benefit Amounts |
| Total member cost | $12,000 | $4,000 |
The bottom line
A liver transplant can save a life — but it shouldn’t destroy financial stability. Under a traditional PPO, even one out-of-network specialist can double your costs, thanks to separate deductibles, higher coinsurance, and balance billing that doesn’t count toward your limit.
With Sidecar Health, members know their Benefit Amounts upfront and, for surgeries and complex care, can work with the care search assistance team that helps coordinate high-quality, high-value providers whose prices are at or below the Benefit Amount — so they never owe more than their deductible.
Disclaimer: All dollar amounts shown are estimates for illustrative purposes only. Actual costs and benefits may vary by provider, market, and individual plan design. Sidecar Health doesn’t use provider networks; instead, the plan pays the average local cost of care for services. Members choose to see whatever provider they want knowing they can share in the savings or be responsible for costs that exceed what the plan pays. The unplanned care protection applies in either case.
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