- Does the plan allow seeking out and using specialists that you need?
- Which hospitals can you use?
- Does the policy cover the type of medicines you need?
- Does the plan cover the specific procedures and therapies you need?
- Does the plan limit the number of times per year that a certain item or procedure will be covered?
- Does the plan cover assistive technology?
- Does the policy cover assessment for mental and physical disorders?
- Is there a lifetime maximum limit on what the policy will cover?
- Ask to work with one insurance case manager. This helps both the consumer and the insurance company by having one person that knows your needs and can manage your claims effectively. It is best for the individual or family to communicate with this person on an ongoing basis.
- If you are denied coverage for a therapy, treatment, or an assistive device that you know you need, don't take "no" for an answer. Ask for the exact reason for the denial. Then collect all documentation that explains the need for treatment and consult your insurance policy for the proper appeals process. Insist that your insurance company and all health care providers supply all information related to the claim in writing.
- Keep detailed, written records of everything related to your child's condition. These will also be very helpful for tax deductions and in all necessary stages of appeals.
- Don't hesitate to appeal decisions that are not in your favor.
- Ask your employer to change the benefits in your company's plan if the current benefits exclude what you need covered.
- The individual has had continuous medical coverage for at least 18 months;
- The individual has already met a pre-existing condition exclusion period; and
- The individual has not been without insurance for more than 62 days.
Health Insurance Marketplace HealthCare.gov
Also known as the health insurance exchange, the Health Insurance Marketplace helps uninsured people find health coverage that meets their needs and budget. Part of the Affordable Care Act.
Take Care Utah
Health insurance outreach and enrollment assistance to Utah residents. Also provides training and resources to community-based organizations that assist Utah's diverse populations and needs. All services are provided free of charge; a partnership between the Association for Utah Community Health (AUCH), the Utah Health Policy Project (UHPP), and the United Way 2-1-1.
National Disability Navigator
This fact sheet is intended to help Navigators answer specific questions that people with disabilities might ask about benefits and coverage available through the Health Insurance Marketplace, supported by the American Association on Health and Disability (AAHD).
Free, confidential tool that helps you find government benefits children/families may be eligible to receive. Extensive.
Official U.S. government site for Medicaid services.
Official U.S. government site for Medicare services.
Tutorial on Medicaid and CHIP Health Insurance
A tutorial on the basics of Medicaid and CHIP, the many different populations these programs serve, the changes they are undergoing as a result of health care reform and some options to help readers think about opportunities to improve services for CSHCN through communication and collaboration with Medicaid and CHIP staff. A collaboration of NASHP and the Catalyst Center.
Catalyst Center: Financing Care for CSHCN
The Catalyst Center is dedicated to improving healthcare coverage and financing for children and youth with special health care needs (CYSHCN). It is funded by the federal Maternal and Child Health Bureau, Health Resources and Services Administration, and US Department of Health and Human Services.
Social Security Administration
Disability determinations are generally made by a disability determination service (DDS) and can take several months. However, if a child has a diagnosis that provides for presumptive eligibility, a letter from the doctor certifying the diagnosis and its severity will allow for the patient to begin to receive services for up to 6 months while the application is being processed.
Voices for Utah Children
User friendly web site provides information and tools you can use to find: The Utah KIDS Count Project collects and publishes statistics that measure the status of children in Utah. Learn more about issues and elected officials and effect change through web-based grassroots efforts.
Provides online applications to Utah programs for children, including Baby Watch Early Intervention, Baby Your Baby, Head Start, Early Head Start, and Children with Special Health Care Needs (CSHCN).
Utah Insurance Department
Fosters a healthy insurance market by promoting fair, reasonable and responsive practices that ensure available, affordable and reliable insurance products and services.
Family Insurance Coverage for a Disabled Adult ( 115 KB)
Utah law, http://le.utah.gov/~code/TITLE31A/htm/31A17102.htm, about requirements for health insurance; from the Utah Family Voices Health Information & Support Center.
Growing Up ( 118 KB)
A fact sheet about planning the the health care transition of youth with special health care needs; topics include health care finance, guardianship, SSI, medical home, and how Family Voices can help; from the Utah Family Voices Health Information & Support Center.
Health Insurance Tips ( 34 KB)
One-page of tips on health insurance from the Kentucky Commission for Children with Special Health Care Needs.
Parent's/Caregiver's Transition Worksheet ( 52 KB)
A worksheet to help parents and caregivers determine strengths and needs to help their youth transition to adulthood; from the Utah Family Voices Health Information & Support Center.
Youth/Young Adult Transition Needs Assessment ( 91 KB)
A worksheet to help the youth or young adult determine strengths and needs to help prepare for transition to adulthood; from the Utah Family Voices Health Information & Support Center.
Tracking Medical Bills ( 125 KB)
This form, developed for Tennessee's Family Information Notebook, provides a way to track bills including dates, insurance company, who paid, and more. For a PDF version and other forms, see the Care Notebook page.
Transition Timeline ( 32 KB)
This sample timeline from the Intermountain Collaborative in Utah, for ages 2-22, provides suggestions for things that parents and providers should be teaching and checking as children transition through different age ranges and on to adulthood.
Use SSI to Get Ready for Your Future ( 33 KB)
This handout provides brief tips for young adults as they consider how work will impact their SSI and Medicaid Benefits; from the Kentucky Commission for Children with Special Health Care Needs.
UnitedHealthcare Children's Foundation
The UnitedHealthcare Children's Foundation is a nonprofit charity. Apply for grants for medical needs not covered or not fully covered by a commercial health insurance plan.
See all Health Insurance Advocacy services providers (15) in our database.
See all Health Insurance, Other services providers (65) in our database.
See all Health Insurance/Funding, Transition services providers (44) in our database.
See all Public Health Clinics services providers (34) in our database.
See all Public Health Services services providers (58) in our database.
For other services related to this condition, browse our Services categories or search our database.
|Contributing Author:||Gina Pola-Money - 12/2005|
|Reviewing Author:||Alfred Romeo, RN, PhD - 7/2008|
|Content Last Updated:||12/2008|