Tips From Real Families Like Yours

O’Hanlon Family Story

Pat O’Hanlon and her husband welcomed their son Kenny into the world when he was only at 28 weeks. Because he was born so prematurely, Kenny suffered a brain bleed early in life, which caused him to have cerebral palsy. The O’Hanlon family does extensive research to evaluate their insurance options each year to ensure that the majority of Kenny’s health care services are covered. “It can be a hardship,” said Pat, “but we want to make sure Kenny can keep seeing his physicians who he is getting excellent care from.”

Q: What services did Kenny have most often when he received care at Children’s Specialized?
“We went to the pediatric practice, that was our primary care physician and we saw him every 3 months and more often if needed. He also saw an orthopedic doctor who initially diagnosed him and did a number of surgeries and wrote scripts for therapies. And then he sees a physiatrist, neurologist, urologist, nephrologist, gastroenterologist and a doctor who specializes in blood pressure.”

Q. Does your insurance cover most of those services?
“We will only purchase insurance that covers everything. So it can be quite an ordeal – especially when renewals come up because we are paying the premiums – to find the right company and the right price. It is important that we make good decisions because we can usually get almost everything covered, including equipment, which is very expensive. It is a lot of work but in the long run we found it worth it to pay for higher premiums to get the coverage.”

Q. What treatments do you find are usually uncovered?
“One of the drugs Kenny takes is a compound that costs $675 per month and insurance companies don’t cover that. That’s a big one.”

Q. What tips do you have for parents as they look at their insurance options?
“Don’t assume anything. Keep asking until you are sure you understand your coverage. Once you get in the middle of it, you’ve got what you’ve got and you could be facing very large bills.
Through the years, I discovered that there was case management (or health coaches, as some insurers call them) available through the insurance provider and I take advantage of that. I didn’t even realize those things were available. Last year, when Kenny needed a new wheelchair that cost $50,000 I got a case manager involved right from the get-go. I had no problem getting it covered. You have to take advantage of those resources - it’s definitely helpful.
Keep good records once you start using your insurance. It is so important.”

Fennelly Family Story

Megan Fennelly’s 11-year-old son, Ben, has autism. “He has a whole host of specialists who we have gathered as his team over the years. I’ve relied on my insurance to help us get him the medical and behavioral care he needs. It’s very important for me to maximize our insurance benefits,” said Megan.

Q: How do diagnosis codes impact how services are covered by your insurance?
“My son was diagnosed with autism and the doctor prescribed speech therapy. My insurance did not cover speech therapy for autism. However, it did cover speech therapy for verbal apraxia, which my son also was diagnosed with during his speech evaluation. His speech therapy is now covered by using the diagnosis code for verbal apraxia. If you think a therapy isn’t covered, it’s important to do some digging and enlist outside help if needed to identify if there’s another solution.”

Q: What is your advice for parents who are looking for health insurance?
“Every parent wants the best possible health care for their child. By taking the time to educate myself about our insurance policies and procedures, I was able to get my son the treatments that he needed. Children’s Specialized Hospital, as well as other specialists, make up the team that have helped his body to heal and make huge gains cognitively. A key lessoned that I have learned is to make sure services are properly coded during the claim process.”

Velasco Family Story

In 2007, three members of the Velasco family were in a serious car accident. Seven-year-old Matthew was gravely hurt in the crash, sustaining a Traumatic Brain Injury.

“After the accident, Matthew was taken to a trauma center, where we spent 10 to 12 days,” said Matthew’s mom, Lori. “Our journey with Children’s Specialized began with six weeks of inpatient rehab before he was discharged. He received cognitive rehab, physical and occupational therapy and neurological rehab. He missed all of second grade.”

With the help of the services he received at Children’s Specialized, Matthew has made a full recovery and is now thriving. However, this experience underscored for the Velasco family the importance of having robust health insurance coverage.

Q: Did your insurance plan cover the services Matthew needed during his recovery?
“All of his rehab and therapy services were at least partially covered, but the issue was more of how many were covered. Our insurance only paid for so many physical and occupational visits—15 per year. He easily exceeded that because he was going for therapies each week for over a year.”

Q: How did this experience impact your insurance purchasing decisions?
“You have no idea how expensive being in the hospital is. Now we do a lot of research on insurance and we are more selective. You have to make sure that you’re covered for anything because you never know what’s going to happen.”

Q: What tips do you have for parents as they look at their insurance options?

• “People don’t take into consideration all of the extra costs of being in the hospital. Gas money, eating out, at-home therapy tools— those aren’t covered by insurance. Make sure you look at all of your expenses.
• If your child receives psychology services, be sure to inquire about coverage – these services often have different limitations that other therapies.
• You need to be the best advocate for your child.”