What Should I Look for in a Quality Health Plan for My Child?
Even if you are healthy, it can be difficult to get the kind of medical care you know you deserve. And with insurance companies and HMOs determined to save money, your child risks being denied the quality of care he needs in order to thrive. As a result, choosing the right health plan is more confusing and time consuming than ever before.
While nearly all health plans cover physician and hospital services, there are fundamental differences in hospital pediatric services you need to be aware of.
Review the following checklist to determine if the health plans you are considering are well managed and cover your disabled child’s needs appropriately.
| Questions to answer: | Yes | No |
|---|---|---|
| Does the primary care clinician have the authority to approve most or all medically necessary pediatric specialty services? | ||
| Does the plan allow for simplified and flexible service authorization policies for children with chronic conditions? | ||
| Does the plan apply a medical necessity standard based on the needs of children? | ||
| Does the plan’s quality management for children include peer review by pediatricians? | ||
| Does the plan regularly monitor effectiveness of treatment for chronic childhood conditions in addition to asthma? | ||
| Does the plan monitor appointment waiting times and distance to specialty pediatric health professionals? | ||
| Does the plan offer any training for clinicians related to the care of children with chronic conditions? | ||
| Does the plan conduct regular satisfaction surveys focused on the experiences of families whose children have chronic conditions? | ||
| Does the plan assure family access to medical records? | ||
| Are families whose children have chronic conditions involved in planning, service coordination, policy development and quality assurance? | ||
| Does the plan offer formal health education or disease management programs for children and families with chronic conditions (e.g., diabetes, sickle cell disease, asthma, oncology)? | ||
| Does the plan offer family support programs for families who have children with chronic conditions? | ||
| Does the plan require accommodations for handicap accessibility in all primary and specialty care offices? | ||
| Does the plan offer case management or care coordination services for children requiring multiple services? | ||
| Does the plan allow for second opinions as an in-plan benefit? | ||
| Does the plan have coordination arrangements with: | ||
| early intervention program | ||
| school | ||
| public health agencies | ||
| Does the plan make available to families a listing of state and community-based programs for children with chronic conditions? | ||
| Does the plan adjust the capitation payments of primary care clinicians who serve children with chronic conditions? | ||
| Does the plan reimburse for special or prolonged service CPT codes? | ||
| Does the plan offer primary care providers who serve children with chronic conditions an enhanced case management fee? | ||
| Does the plan offer any performance or financial incentives to promote early identification, shared management, and state-of-the-art treatment of chronic childhood conditions? |
Download the “Ensuring Service Quality” checklist in PDF
If you are concerned about the cost of health care, and if your doctor failed you and your baby in any way, then you might be entitled to financial help. Contact 4MyChild today to see if your child is eligible for Benefits4Life.
