Health Insurance
Parents who have children with special needs have many responsibilities, including paying health care providers that work with their child get paid. It can be difficult to understand the health care insurance system, so here is an introduction.
There are two basic types of health insurance. The indemnity plan is a plan in which patients can go to any doctor or specialist for services and be reimbursed by their insurance company. A managed care plan can take many forms, such as a health maintenance organization, a preferred provider organization, or a point of service plan. Basically, all managed care plans require individuals to have a primary care physician that is affiliated with the plan. This primary care physician can then refer individuals to specialists, which must also be affiliated with the plan. Individuals who obtain health care from a physician, specialist or hospital that is not a part of the managed care plan network of health providers may have to pay for part or all of the service using their own money. Many insurance plans will require prior authorization for services. This means the patient must request permission for a service from the insurance company before the service is given. Insurance companies often have case managers, who act as a coordinator of a child’s and family’s health services, and work with the family and other service providers. Case managers can also help families who have been denied services with filing appeals, or written protests regarding the insurance company’s decision about health care services.
Health care financing is complicated, and can involve many hidden fees. Most health plans charge an annual premium. Employers that provide health insurance benefits may pay part or all of the premium. Some plans charge a deductible, which is a percentage or dollar amount of money you must pay for a service each year before the insurance company begins to pay. Many health plans require a copayment or copay for certain services each time you receive the service (e.g., $5 for a physician’s visit, $10 for a specialist visit, $10 for medication, $50 for a hospital visit, etc.).
A wide variety of arrangements for financing health care is available in both the private and the public sector. Success in paying for the comprehensive medical services your child needs may come from a combination of the following private and public resources.
Children’s Medical Security Insurance Plan (CMSIP) provides assistance with health coverage for children through the age of 18 who currently do not have any health insurance coverage and whose families meet the income eligibility requirements. Children enrolled in CMSIP will receive a comprehensive set of medical and dental benefits that include speech and language services and physical and occupational therapy and rehabilitation. For information contact your local Department of Social Services or the number listed.
1-877-822-6747
Fairfax County Office of Partnerships Medical Care for Children Partnership (MCCP) provides comprehensive health care benefits to eligible children living in Fairfax County through Kaiser Permanente.
(703) 324-5171
Fairfax County Office of Partnerships and Kaiser Permanente Bridge Program provides comprehensive health care benefits to eligible participants living in Fairfax County for a maximum period of 24 months.
(703) 324-5171
Medicaid Waiver Services are health care, residential, vocational, in-home support, respite, technology, personal assistance and transportation services that people with specific disabilities can receive as an alternative to placement in a state institution or nursing home. The type of services offered depend on the person’s age and disability.
(804) 786-1465
Arlington Department of Human Services Financial Assistance administers the Medicaid, medical care, food stamp, housing, and child care assistance programs to individuals and families in Arlington County who meet income and other eligibility requirements.
(703) 228-1350
Alexandria Department of Social Services administers the Medicaid, medical care, food stamp, housing, employment and child care assistance programs to individuals and families in Alexandria who meet income and other eligibility requirements.
(703) 838-0720
Fairfax County Department of Family Services administers the Medicaid, medical care, food stamp, housing, employment, and child care assistance programs to individuals and families in Fairfax County who meet income and other eligibility requirements.
(703) 324-7800
Medicine Program provides prescription medication to individuals who qualify for a $5.00 processing fee.
1-573-778-1118
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