Insurance and Pediatricians: What You Need to Know

When your child needs a doctor, the last thing you want to worry about is whether your insurance will cover it. And yet, this is an important concern for every parent. Receiving medical care without adequate insurance can lead to serious financial difficulties, depending on the care and treatment needed.

To avoid potential snares, here are three important things every parent should do before setting up an appointment with a pediatrician.

1. Make sure the Pediatrician accepts your insurance plan

This is an easy one, and only requires a phone call or email to the pediatrician’s office with your insurance details. Yet it’s surprising how many people skip this step, or think it is unnecessary, and end up having frustrating conversations with clinic staff about insurance.

Whether your insurance plan is private or government-sponsored, you need to know whether the pediatrician will accept that kind of insurance. Most clinics will ask about your insurance when you book an appointment, but if there’s any doubt, calling again is the best way to insure a smooth visit.

2. Understand the Affordable Care Act!

We know you’ve probably heard it before, but the Affordable Care Act has made significant changes to the way health insurance operates in the United States. It is now mandatory for all Americans to have health insurance. Those who choose not to be insured are subject to significant financial penalties when tax season rolls around.

The good news is, if you don’t have health insurance for your child, purchasing a plan from the government makes a lot of sense, especially given the heavy fees you’ll face for each person in your home who goes without insurance. When you add up these fees, the same amount of money would go a long way toward buying insurance, which would actually put your money to good use.

But remember, you can only enroll in the government’s insurance plan for roughly four months out of the year. Make sure you understand Obamacare and be aware of the annual enrollment periods.

Obamacare is not your only option. If you lack private health care from your employer or that of your spouse, the Affordable Care Act has made other changes that can help you. Specifically, it expanded Medicaid and made it available to Americans who live in low income situations. Whether or not you and your child qualify for Medicaid depends on your State of residence and your level of income—but New Jersey is among the States that is participating in expanded Medicaid, so if you’re a resident of our State, it’s worth looking into your Medicaid eligibility.

3. Understand your rights in an emergency

We’ve all heard stories of people being refused treatment for lack of insurance. When your child has an emergency situation, it’s important to know your rights as a citizen.

The Emergency Medical Treatment & Labor Act of 1986 says that any clinic or hospital who accepts Medicare or Medicaid patients (and the majority of clinics and hospitals fall into this category) must provide emergency care to all patients who need it, even if the patient lacks health insurance. This means that emergency care is obligatory for most medical institutions on the United States. If your child needs emergency care, but does not have health insurance, be honest about the situation—and if refused care, confirm that the hospital is private and does not accept Medicare or Medicaid patients.

Any hospital or clinic can refuse treatment for lack of insurance, or inability to pay, when they determine that there is no medical emergency. Since most pediatric care falls into the non-emergency category, organizing health insurance for your child is a top priority in order to establish regular, for long-term pediatric care.

We hope this article has given you some valuable information on insurance and pediatrics. If you have any questions or comments, please leave them in the space below. We’d love to hear from you!