Family Network on Disabilities

INformation Hub

Understanding your Health Insurance

Understanding your Health Insurance

When your child has a chronic illness, condition, or disability you become your child’s primary health advocate.  Most families can become blinded or even blindsided by unexpected medical bills or even additional fees. Learning to manage your money in a medical crisis isn’t impossible. To do this you must understand the health care system.

Learn the meaning of insurance language, such as:

    • co-pay: the part or percentage of the bill you are responsible for

    • deductible: the amount you must pay before your insurance company will pay for services

    • referral: your insurance company may require the primary care doctor to refer your child to another doctor or specialist before your insurance company will pay for services performed by another doctor

    • precertification: you may have to let your insurance company know in advance about any medical tests or treatments the doctor has ordered. If you do not precertify before receiving treatment, the procedure may not be covered.

    • network provider: any doctor, hospital, or another provider of medical services who has agreed to participate in your insurance company’s network and to offer their services at negotiated rates. Also called a participating provider.

    • pre-existing condition: an injury or illness that existed prior to the effective date of your current insurance policy

    • usual, customary, and reasonable: refers to the amount usually charged by health care providers for services and treatments in the area where you live

Understand your health cares design, ask your insurance provider for your policy design or check out their website.