Understanding insurance coverage

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Transplant Talk - Boston Children's Hospital Fall 2015

Learn tips to ensure changes you make to your family's health insurance don't negatively impact your coverage.

Health Insurance

Considering a change in insurance? Be thorough in your research.

Typically, most patients are allowed to update or make changes to their insurance coverage once a year, during an open enrollment period. If you are thinking about altering or updating your family's health insurance in any way, please consider the following:

  • Before altering or picking a new plan, always make sure Boston Children's Hospital and your current Pediatric Transplant Center doctors are covered in the plan’s network.
  • Read all of the plan materials thoroughly.
  • Evaluate your health care costs when making your annual enrollment decisions, factoring in copays, deductibles, premiums, etc.
  • Review the coverage for medication, and make sure you fully understand the cost of copays for prescription medications.
  • Remember, once you have enrolled in a health plan, you likely will not be able to make changes until the next open enrollment period.

Referral? Who needs a referral?

If you are enrolled in an HMO plan you will need to get a referral before obtaining medical care from anyone except your primary care doctor. A referral is a written order from your primary care doctor for you to see a specialist or get certain medical services. If you don’t get a referral first, the insurance may not pay for the services. Make sure you know the scope of what your referral covers such as number of visits, time frame of visits, scope of services.

Transplant Finance Team
Your finance team: Angela Perry and Shannon Foley

Government Sponsored Insurance

Are you covered by a standard Medicaid or a Managed Care Medicaid Plan from another state? Be sure that the plan allows you to have services at Boston Children’s Hospital. Some plans require that you have your local physician request authorization prior to your visit at Boston Children’s.

If after studying available plans and speaking with representatives from your insurance provider you are still unclear about options available to you, our office may be able to help. Please contact financial coordinator Angie Perry at 617-355-0137 or angela.perry@childrens.harvard.edu, or contact our new transplant financial coordinator Shannon Foley at 617-355-8319 or shannon.foley@childrens.harvard.edu.

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944