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Health insurance: what you need to know

Health insurance white boardYou’ve heard the saying, “what you don’t know can hurt you.” When it comes to health care insurance, what you don’t know can COST you.

We’re here to help you better understand health insurance in general because information is power. And, when it comes to your child’s health, it’s very important to know what your insurance will and will not cover.

At Cook Children’s, we want every child to have access to the best pediatric care possible. Not all insurance policies provide coverage for specialized medical care for children. Here, we provide you with information you need to choose a plan that covers your child’s unique needs.

Did you know ... even though Marketplace open enrollment is over for 2014, you may still have options for coverage?

While the next open enrollment begins on November 15, 2014, Cook Children's patients and families may still be able to get coverage. You can enroll in the ACA health plan if you've had a qualifying life event or a complex situation. Learn more at HealthCare.gov.

We provide basic information on health insurance, what kinds of policies are available, how to save money on insurance costs, who to contact when you have insurance questions and the kinds of coverage available to children in Texas under the new health laws. We also provide direction on where to turn for help if you run into complications. It is important to understand insurance and we're here to help give each family the tools they need to find the best coverage for their needs, so you can keep your focus on the child that matters most ... yours.

First things first

You protect them from the rain, the cold, even pretend monsters.

But did you know you can take that protection a step further by learning all you can about your insurance coverage? Understanding your health insurance coverage will protect you and your family from the unexpected. Find out what you should know, here..

When negotiating insurance contracts with insurance companies, Cook Children's is always focused on ensuring the best quality of care and coverage on behalf of the children and families we serve.

There are hundreds of health care plans and each one is different. Even employer-provided plans of the same name may be different from company to company, depending on the types of coverage your employer selects. For this reason, you should check with your health insurance plan to ensure that Cook Children's is included in your health plan's provider list. Children are not small adults and having them treated by pediatric doctors and medical experts who understand kids helps to ensure the very best care for your child.

You should also note that insurance plans change provider lists quite often. Anytime your child is referred to a specialist or requires medical treatment, it’s helpful to check with your health insurance plan before scheduling an appointment or procedure. Not checking with your health insurance plan could result in large expenses that aren't covered under your insurance plan. This means you will be required to pay out of your pocket for uncovered doctor and medical bills.

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Things to know when shopping for insurance

Every year, people change health plans for various reasons, but what you may not realize is that every plan offers a different list of health care providers. In fact, sometimes a plan will change during the year, dropping and/or adding health care providers. These changes might mean that your current doctor, hospital, specialist and other medical treatment and medical service providers may not be covered and this can have an effect on the coverage of care for your child. This isn't related to the current changes in health care; it's related to negotiations between health insurance plans and medical providers. Shopping for insurance or choosing between plans offered by your employer can be confusing and overwhelming, but if you're armed with the right questions, you can make wise choices that are best for you and the needs of your family.

What to ask

To help you through the process, here are some helpful questions to consider as you shop for health insurance:

Does the plan...

With the plan...

Know your benefits

Knowing what medical care is covered for your child and which medical providers, such as doctors, specialists, hospitals, etc., are covered under your plan can help you in making decisions about your child's needed medical care and where to take your child for care. By performing an annual review, you can also determine if the policy you have offers the level of care you, your child and your family need and whether you may need to look at other policies.

One size does not fit all.

There are many different health insurance plans, and each of them offers a whole lot of different benefits and benefit options. The more you know about the kinds of policies available, the easier it will be to find the one that fits your family's needs.

If you already have health insurance coverage, it's very important to review your plan benefits. Commercial plans change quite often, so your coverage and your list of providers may not always be the same. If you're unsure about your benefits, check with your health insurance plan provider. Most insurance companies offer online access to your account through their Web site. You can also contact your health insurance plan at the number on your member services card.

If your insurance is employer-provided and you're unsure about how to contact your health insurance plan, please check with your employer's benefits administrator. She or she may also be able to go over your benefits with you.

If Cook Children's isn't in your plan

If Cook Children's isn't listed as a provider on your health insurance plan, you may still have covered options which you can discuss with your health insurance plan. If you would like to have your child seen by a Cook Children's pediatrician or specialist or to undergo pediatric care and treatment at a Cook Children's Health Care System facility here are some questions you should ask your health insurance plan administrator:

If you're expecting a baby

Many people assume that they have lots of time after their baby is born to enroll them on their health insurance plan. This isn't always the case. For the health of your baby and to make sure unexpected charges don't hit your budget, be sure to enroll your baby within the first 30 days after the baby's birth. At Cook Children's, we recommend even sooner. Most babies are born strong and healthy, but it's always better to be prepared.

Is your child eligible for Medicaid and/or CHIP?

Depending on your family size and income, your child may be eligible for Medicaid and/or CHIP. This means that you may be able to access free or low-cost care for your child through the state of Texas.

The state has existing coverage options that could work for you - particularly if you have children, are pregnant or have a disability.

You can apply today by contacting your state Medicaid office.

You can also apply by filling out an application in the Marketplace online.

Medicaid and the Children's Health Insurance Program (CHIP)

In many cases, if you qualify for Medicaid your children will qualify for either Medicaid or CHIP. CHIP may also provide coverage for children whose parents make too much money to qualify for Medicaid. Learn more about CHIP and Medicaid from the state of Texas here.

What if you're uninsured or underinsured and can't afford services?

There are some cases where certain hardships simply seem impossible. Part of the Cook Children's Promise is to improve the health of every child in our community. Sometimes this means lending a helping hand by providing charity care or financial assistance to eligible patients. The key qualifications for charity care and/or financial assistance include children who:

These financial options are available to children who are admitted to Cook Children's Medical Center on an emergency basis and don't have the resources to pay for the services. We may also assist families whose children are in current treatment and require financial assistance with other aspects of a child's care which might include such things as lodging, transportation, etc. This is done on a case-by-case basis and only after all other sources of assistance have been explored and/or exhausted. All charity or financial assistance will be granted, if qualified, without regard to gender, sexual orientation, race, creed, color, ethnicity or national origin. Our primary goal is care for the child.

You can learn more about the Cook Children's financial assistance policy here.

To learn more about the charity care and financial assistance offered through Cook Children's and/or to apply for assistance, click here.

Appealing insurance denials

If your health insurance plan denies a service or payment you can appeal it. The following information is provided by the Patient Advocate Foundation, a national non-profit organization that serves as an active liaison between the patient and their insurer, employer and/or creditors to resolve insurance, job discrimination and/or debt crisis matters relative to their diagnosis through case managers, doctors and attorneys. Patient Advocate Foundation seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability. For more information on Patient Advocate Foundation, go to patientadvocate.org.

Click here for a guide on navigating the appeal process.

Who to ask

If you have questions, the best place to get answers is through your health insurance plan. If your health insurance is employer-provided, you can also contact your company's benefits administrator.

Still need help?

If your child is at Cook Children's or you would like to have him or her seen at Cook Children's but don't qualify for Medicaid and can't afford any other type of health insurance, we are happy to help. To learn more or for information and assistance getting your child covered right away, click here now.

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