When coming to Seattle Children’s for care, there are 3 main things to consider about your insurance plan:
The amount you owe depends on the insurance plan you have. Your cost is determined by your plan benefits like copay, coinsurance, individual and family deductible amounts, as well as the type of services your child receives.
We can provide an estimate based on what we know about your child’s treatment. If we do not know what the doctor will do or recommend, we cannot estimate the cost for treatment.
We can give you better information if you are able to find out some information from your insurance in advance. Please call your insurance company for answers to these questions:
- Is Seattle Children’s an in-network provider?
- What is the copay for specialty care?
- How much of my child’s (individual patient) deductible have we met for the year?
- What is my coinsurance percentage?
- How much of our family deductible have we met for the year?
- What is my individual out-of-pocket maximum?*
- What is my family out-of-pocket maximum?
* When Seattle Children’s is an in-network provider, your total bill for each patient should not be more than the individual out-of-pocket maximum for your insurance plan.
Visit our Insurance Frequently Asked Questions page.
Most insurance plans do not require pre-authorization for a specialty clinic consult. If the specialist orders additional tests, therapies or procedures, our insurance authorization team will request authorization from your insurance plan.
Kaiser Health Foundation Plan of Washington (formerly Group Health Cooperative), NPN, HMSO and TriCare insurance plans always require a pre-authorization before scheduling care at Seattle Children’s. If your child is covered by Kaiser Health Foundation Plan of Washington (formerly Group Health Cooperative), NPN, HMSO or TriCare, make sure you have your authorization number before you schedule an appointment.
If your insurance denies our authorization request, meaning they will not pay for services, we will contact you. Because of the high volume of requests we do each day, we will only notify you if our request is denied.
Pre-authorization does not guarantee your insurance will cover care. Some services do not require pre-authorization, but also are not covered. Because employer groups can customize plans for their employees, there is a wide range of plans and coverage. Contact your insurance to learn what your plan covers.