My child is a patient at Seattle Children’s, or I want my child to be seen at Seattle Children’s in the future. What do I need to know about my health insurance coverage?

Exchange plans (Washington Healthplanfinder)

If you buy health insurance on Washington Healthplanfinder that covers your child, Seattle Children’s is currently not covered by all of the plans. Seattle Children’s is covered only by these Exchange plans:

  • Ambetter (Coordinated Care)
  • BridgeSpan (Regence BlueShield) starting January 1, 2015
  • Community Health Essentials (Community Health Plan of Washington)
  • Group Health Core (Group Health)
  • Heritage Prime/Heritage Signature (Premera)
  • LifeWise Connect (Premera)
  • Molina Marketplace (Molina)

If you choose an Exchange plan from another insurance company, Seattle Children’s is considered “out-of-network” for these Exchange plans, and your plan may not pay for your child’s care here.

Other insurance plans (outside of Exchange or employer plan)

When choosing any plan, even a plan purchased through your employer or outside of the Exchange, you should always make sure Seattle Children’s is an in-network provider so that your child can continue care or get care here in the future. See the full list of all plans that include Seattle Children’s

Narrow network plans have two deductibles: One for services at in-network providers and one for services at out-of-network providers. Out-of-pocket costs could be higher if your child visits a provider who is out-of-network with your insurance plan.

Which insurance plans include Seattle Children’s for mental health services?

See which insurance plans include mental health services at Seattle Children’s.

What can I do if my insurance plan doesn’t cover Seattle Children’s, I was denied coverage or I am unhappy with my insurance?

You are the best advocate for your child. We encourage you to call the Office of the Insurance Commissioner (OIC) with concerns; the providers your insurance recommends; the timeframe for getting a response; or anything else about your health insurance. The OIC oversees the insurance industry and protects you as an insurance consumer.

Why is Seattle Children’s not a provider on all plans?

We continue to negotiate with insurance companies. Despite our best efforts, we have found that some companies have chosen not to contract with us.

Our hope is that all health insurance plans will cover Seattle Children’s, so we can serve your child and all Washington families.

I’m an adult patient at Seattle Children’s. How do I get coverage?

Contact our financial counselors, and they will help you.

What if my child is seen at Seattle Children’s and does not have insurance?

Contact our financial counselors, and they will help you.

What should I consider when comparing health insurance?

When comparing, consider these things:

  • What is covered?
  • What is my monthly cost?
  • What is my deductible?
  • What is my coinsurance and copay?
  • Which providers can I see with this plan?
  • What is the annual out-of-pocket maximum for in-network services and annual out-of-pocket maximum for out-of-network services?

I am a Boeing employee and have a choice between two new affordable healthcare plan options in 2015. What is an Accountable Care Org (ACO)? Is Seattle Children’s in both of these?

Boeing is partnering with two leading healthcare systems in the Puget Sound region – Providence–Swedish Health Alliance Network and UW Medicine Accountable Care Network. Each system has a broad provider network, including primary care providers, specialists and hospitals. Seattle Children’s Hospital (and its regional clinics) are included in the UW Medicine Accountable Care Network, along with MultiCare Medical Center & Clinics; UW Medical Center & Clinics; Valley Medical Center & Clinics; UW Physicians; Children’s University Medical Group; Harborview Medical Center & Clinics; Northwest Hospitals & Clinics; Overlake Medical Center & Clinics; Cascade Valley Hospital & Clinics; Skagit Valley Hospital & Clinics; and Island Hospital & Clinics. Learn more.

Resources

For Affordable Care Act information including the following, visit Healthcare.gov.

  • Tax credits
  • Lowering premiums
  • Qualifying for Medicaid
  • Help enrolling
  • Help choosing a plan

More information