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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 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. Plans on the Exchange begin coverage Jan. 1, 2014.

The deadline for open enrollment is March 31, 2014.

Will I have to go to the Exchange to get health insurance?

  • If you have individual insurance, and you are able to keep your policy: You do not need to do anything.
  • If you need individual insurance because your policy is going away, your employer doesn’t provide it or you don’t have it now: You will need to go to the Exchange to buy it.

You will need to enroll by March 31, 2014.

My child is a patient at Children’s. What do these changes mean for me?

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

  • Group Health Core
  • Community HealthEssentials
  • Molina Marketplace

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

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.

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 Premera/LifeWise Connect 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.

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 Children’s. The only Exchange plans that have Children's as "in-network" providers are Group Health, Community HealthEssentials and Molina Marketplace.

Why is 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.

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 Children’s, so we can serve your child and all Washington families.

Is there anything I can do to help 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 Children’s. How do I get coverage?

Contact our financial counselors, and they will help you.

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

Contact our financial counselors, and they will help your child get covered.

What if my child is covered, but I need health insurance?

Visit Washington Healthplanfinder to set up an account, and shop for a plan.

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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