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Questions to ask

When choosing a plan, there are many things to think about. However, there are also a few very important questions you will want to ask when deciding which policy to buy.

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Questions to ask of the health insurance plan

Questions to ask your current or potential medical provider about plans you are considering

If your plan is offered by your employer, questions for your benefits administrator

Questions you may have about billing and insurance

Is my child's care covered under my insurance?

Every plan varies, including what services are covered and which providers are covered for payment under the plan. Prior to making an appointment or scheduling a service or treatment, you will want to check with your insurance plan provider to ensure that your child's care is covered under your particular policy. Prior to your visit, you will want to contact your health insurance plan with questions about your insurance coverage. It's also important to ask if you will need a referral authorization. If your insurance requires authorization and you don't have it, you could be responsible for the entire cost of the bill for your child's care, services and treatments. You will also want to ask about copayments and any deductibles so you understand what kinds of costs you may be required to pay out of your own pocket.

What HIPP parents know

Even with private insurance and Medicaid, the cost of medicine and care for a child with a serious condition can still create a tight budget. For some families, there may be help from HIPP. HIPP is a state program that assists qualified families with private health insurance costs. Click here to learn more.

Will I owe any money for my child's care?

Any dollar amount you are required to pay will depend on the benefits offered under your health insurance plan. Prior to making an appointment or scheduling a service or treatment, you will want to check with your insurance plan provider to determine what your out-of-pocket costs will be, if any. The amount is typically determined by whether or not the care is covered under your policy and what your copay and deductibles are. Copays are due at the time services are provided; any deductibles and out-of-pocket expenses you are responsible for will be due as well.

Who do you bill for my child's medical care?

For scheduled procedures, we bill you for the portion you owe, such as copays an/or deductibles, as well as any portion (out-of-pocket expenses) your insurance may not cover. These fees are due prior to the procedure. We will bill your insurance company directly for their portion. After your insurance processes your claim, you will be responsible for any remaining balance. If you have Medicaid or are on our charity plan, all costs are covered and you will owe nothing. If you don't have any insurance we will bill you directly. Also, depending on your financial situation, we may be able to assist you with receiving Medicaid, in which case your child could be covered for services and treatments we provide. If you need financial assistance, please ask us or visit this page for more information on financial assistance.

How do I know if my insurance has been billed?

Most insurance companies provide online access to your account through their websites. You can also contact your health insurance plan at the number on your member services card. If your insurance is employer-provided and you are unsure about how to contact your health insurance plan, please check with your employer's benefits administrator.

Was my correct insurance billed?

We bill your insurance companies based on the information you provide. We know that during stressful times mistakes can happen. Please check with your health insurance plans if you have questions. Most insurance companies provide online access to your account through their website. You can also contact your health insurance plan at the number on your member services card. If your insurance is employer-provided and you are unsure about how to contact your health insurance plan, please check with your employer's benefits administrator.

How do I make sure my insurance is billed correctly?

Prior to your visit, you will want to contact your health insurance plan with questions about your insurance coverage, copayments or deductibles. Bring the following information to your child's appointment:

You'll find more information on preparing for a visit or stay at Cook Children's Medical Center here: Preparing for a visit

What is pending (waiting to be paid) with my insurance?

There are two ways to check on what has been paid, what is pending and what is owed. You can set up a My eBill account here. Our online account management service lets you view your bills, including recent insurance payments and more. You may also check directly with your insurance plan provider. Most insurance companies offer online access to your account through their website. You can also contact your health insurance plan at the number on your member services card. If your insurance is employer-provided and you are unsure about how to contact your health insurance plan, please check with your employer's benefits administrator.

Why is it taking so long for my insurance to pay?

There are a number of reasons why your insurance has not paid yet. If you are concerned, please contact your insurance plan provider directly. Most insurance companies offer online access to your account through their website. You can also contact your health insurance plan at the number on your member services card. If your insurance is employer-provided and you are unsure about how to contact your health insurance plan, please check with your employer's benefits administrator.

Why didn't my insurance pay a bill?

If you have not received an explanation of benefits from your insurance plan provider you will want to call them directly. If you have received notice from them, you will also need to contact them. Most insurance companies offer online access to your account through their websites. You can also contact your health insurance plan at the number on your member services card. If your insurance is employer-provided and you are unsure about how to contact your health insurance plan, please check with your employer's benefits administrator. In addition, you may want to explore how to appeal a payment denial. Please see "Appealing insurance denials" by clicking here.

What can I do if my insurance denies payment of a bill?

If your insurance has denied a payment, you have the right to appeal that denial.
Guide to Appealing Insurance Denials

What if I don't have insurance? Where can I start?

There are many health insurance options available today. We suggest you begin here:
Helpful Hints on Shopping for Health Insurance

What if I can't pay my bill or the part of the bill I'm responsible for?

If you are experiencing financial difficulties we may be able to help. Please check our information on financial assistance:
Help for uninsured or underinsured children

I still have questions, who can I call?

For questions about your coverage, copayments, deductibles and referral and authorization requirements, read your plan's benefits carefully. If you have billing questions, read all bills carefully to find the phone number to call for assistance. Or call your employer's benefits office for explanations. Not all bills will come from Cook Children's. If you have questions about your Cook Children's Medical Center bill, please call 682-885-4432 or if calling from area codes other than 817 or 682, call toll-free at 888-852-6635.

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