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Health Insurance Changes May Affect Your Child’s Coverage at Children’s

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I’ve heard a lot about healthcare insurance changes. How do they affect me?

As part of the Affordable Care Act, all Americans must have health insurance in 2014.

What are options for purchasing health insurance for my child?

If you buy on the Exchange, you qualify for tax credits or subsidies. If you buy outside the Exchange, you do not. To learn more, visit Where can I buy a health plan? on the website of the Washington Office of the Insurance Commissioner.

What is a Health Insurance Exchange?

Since all Americans are now required to have health insurance, the Health Insurance Marketplace was designed to meet that requirement. The Marketplace (also called an Exchange) is a one-stop shop to find, compare and buy private health insurance options.

Our state’s Exchange is Washington Healthplanfinder. The next open enrollment (enrollment for anyone) is Nov. 15, 2014 to Feb. 15, 2015.

Can I enroll for insurance coverage on Washington Healthplanfinder anytime besides during open enrollment?

Open enrollment (enrollment for anyone) is Nov. 15, 2014 to Feb. 15, 2015. But, you may enroll year-round if:

  • You qualify for or are renewing Washington Apple Health (Medicaid) coverage.
  • You are an American Indian/Alaska Native who is an enrolled member of a federally recognized Tribe or Alaska Native Corporation.
  • You are enrolling in the Small Business Health Options Program offered in Clark and Cowlitz Counties.
  • You experience certain life events like:
    • Getting married
    • Having a child
    • Moving to a new area
    • Losing health coverage

These may qualify you for a special enrollment period. If you already have an account, report a change through your Washington Healthplanfinder account. If you're a new customer, you can apply at on the Washington Healthplanfinder site to see if you qualify.

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:

  • Group Health Core
  • Community HealthEssentials
  • Molina Marketplace
  • Ambetter (Coordinated Care)

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.

We will try to work with your plan, but your child may have to go to the provider your plan covers. Our financial assistance program cannot cover costs for choosing an out-of-network provider.

Is the Premera (or other insurance plan) I have now the same as Premera plans on the Exchange?

No. Even though you may currently have insurance from a company that’s on the Exchange, like Premera, the plans on the Exchange are not the same as the health insurance plan you already have. 

So, for example, if you buy a plan from Premera on the Exchange, we are not an "in-network" provider for them and they may not pay for your child’s care at Seattle Children’s. The only Exchange plans that have Seattle Children's as "in-network" providers are Group Health, Community HealthEssentials, Molina Marketplace and Ambetter (Coordinated Care).

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 about a denial; 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 of the Exchange plans? 

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

Seattle Children’s feels the Exchange plans that have chosen not to contract with us and the Office of the Insurance Commissioner (OIC) did not make sure there were enough specialized healthcare options for children. And, the Affordable Care Act requires “adequate network coverage.” So, we filed a lawsuit against the OIC on Oct. 4, 2013.

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

Is there anything I can do to help Seattle Children’s get on the Exchange plans?

Visit our How You Can Help page to find out what you can do.

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 your child get covered.

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?
  • Which providers can I see with this plan?

Resources

 

Contact Us

Seattle

206-987-5757

Healthcare Exchange Coverage Questions

206-987-3333

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