Trying to manage insurance coverage for your child’s care?
Getting the right medical treatments, therapies, equipment, and other supports in place for your child often means endless paperwork and phone calls with your insurance company. Undivided can help ensure you are getting the most out of your health plan.
How can Undivided help?
1. Try a free Kickstart
During your Kickstart, your Navigator will talk with you about your private insurance and any public insurance programs such as Medi-Cal that your child qualifies for. By going over your priorities and concerns for the future, your Navigator will help you identify goals and the next steps.
2. Make the most of your health plan
In addition to 1:1 support from your Navigator, you’ll have access to all the organizational tools of the Undivided app for your child’s medical documents, claims, superbills, and more. The Undivided app is also home to step-by-step guides, checklists, articles, and videos created with the help of experts so that you can maximize your benefits. You can also schedule a health plan audit, where our Health Plan Advocacy Services team will help you look at your coverage, benefits, and claims to make sure your insurance plan is working the way it should be.
3. Get access to ongoing support
You’ll have access to unlimited messaging with your Navigator and monthly Boost calls throughout the year. Together, you can discuss any additional help you need from our Health Plan Advocacy Services team, such as managing claims for you, following up on appeals, and more to make your life easier. Your Navigator is also here to support you with public benefits, special education, and other aspects of making sure your child has what they need.
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Frequently Asked Questions
What does out-of-network mean?
Out-of-network simply means that a provider has not contracted with your specific (or often any) health plan. To work with this provider, you will access out-of-network levels of coverage on your plan, and will most likely submit your own claims for processing. Learn all about handling insurance claims in our Insurance decoder.
Why would a provider choose not to contract with a health plan?
- Network contract rates have been trending lower in recent years.
- Network contracts may impose limitations on what services are covered by diagnosis.
- Low contract rates may limit the length of sessions that the provider can offer.
Why would I see or be referred to an out-of-network therapy provider?
- Not all of your child’s needs are covered by in-network therapy providers.
- Your child’s primary care physician or specialist may recommend a therapy provider who is out-of-network.
- It’s not uncommon for out-of-network providers to spend more time on clinical discussion with you and other members of your care team.
Is it possible for an out-of-network provider to be covered as in-network?
In some cases, out-of-network providers can be covered at the in-network benefit level if you can prove that your out-of-network provider is uniquely qualified to provide a service that is medically essential.
What insurance benefits can my child qualify for based on household income?
Medi-Cal is California’s Medicaid program for individuals with disabilities and for those who meet certain income limits. Children with disabilities may also be able to qualify for Medi-Cal without counting their parents’ income by using the institutional deeming waiver. You can learn more in our article Medi-Cal 101.
If my family has private insurance, can we still use Medi-Cal?
Families who already have health insurance coverage for their child can still benefit from Medi-Cal, as it may be used as a secondary insurance to pay for certain expenses that primary health insurance doesn’t cover. Check out our article about using Medi-Cal as secondary insurance to learn more about how to enroll, how to get medically necessary supplies and services covered, and how to handle treatment authorization requests (TAR).
Your Navigator is your partner at each turn
Every Undivided Navigator has years of experience supporting families raising kids with disabilities or parenting their own through years of IEP meetings. Partner with an Undivided Navigator for a Kickstart to learn first-hand what support feels like!
What’s your burning question? We’ll help!
We’ll help you find the answer to all your IEP, public benefits, insurance questions, and more.
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