Childhood Cancer

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Your Child in the Hospital

Understand your policy

As soon as you know a hospitalization is necessary, it helps to read your entire insurance manual and make a list of any questions you have about terms or benefits. The human resources department at your workplace can answer questions about your policy or direct you to someone who can.

• Learn who the “participating providers” are under the plan and what happens if you see a “non-participating provider.” You may have to pay more or your claims may be denied if you go to a doctor or hospital that does not have a contract with your insurance company—this is called going “outside the network.”

• Find out when you have to precertify a hospitalization. Many insurance companies require precertification, even for emergencies.

I realized that Christine had been hospitalized for a week, and I had not called the insurance company. When I read the manual, I was upset to find out that there was a two hundred dollar penalty for not calling them, even though it was an emergency admission.

• Find out when a second opinion is required.

• Determine whether your doctor needs to document specific requirements to obtain coverage for expensive or extended services.

With our insurance, occupational therapy, speech therapy, and physical therapy are covered, but the phrasing in the doctor’s orders must be that each service is a “medical necessity.”

• Find out what your deductible is.

• Find out if there is a point at which coverage increases to 100 percent.

Chapter 17: InsuranceFind a case manager

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