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Understanding Health Insurance

Originally published on August 8, 2012
Most recently updated on August 7, 2013

Navigating the health insurance system with a child who is newly diagnosed with a brain tumor can be overwhelming. The following resources offer information about many of the questions you may have as well as options for low-income families and the uninsured. 

The pediatric social worker is a key member of your child’s health care team. One of the things your social worker can do is to help you explore sources of financial aid for which your child or family may be eligible. The hospital financial office may also be able to help you make credit arrangements or see if you qualify for public or private sources of financial assistance. It’s best to apply immediately, because processing can take weeks. 

General Information about Health Insurance:

This resource outlines various health insurance options and issues such as the Affordable Health Care Act, Medicare, Medicaid, how to appeal and insurance claim, and more.
ABTA offers additional information about health insurance and solving problems related to it.
Financial Assistance and Options for the Uninsured:
ACS outlines many issues that cancer patients face in regards to health insurance and financial issues and offers resources to help alleviate some of these issues.
Enacted in 1993, the Family Medical Leave Act (FMLA) requires employers to continue health insurance coverage to an employee on medical leave for up to 12 weeks. This means that a parent of a child with a brain tumor can take up to 12 weeks of paid or unpaid (at the discretion of your employer) leave within a 12-month period. An employee who uses FMLA is guaranteed his or her job or equivalent job at equal pay and benefits level.    
Children's Health Insurance Program (CHIP) offers insurance to low-income families of children who are uninsured. 
Medicaid is a government program that provides insurance for low-income patients. Entitlements vary among states. Contact your local Department of Human Services or Department of Public Assistance to find out whether your family is eligible and how to apply. 
The NBTS resource page offers many links to alternate resources for health insurance needs as well as financial assistance. 
NeedyMeds is an online information resource of programs that provide assistance to people who are unable to afford their medications and health care costs.  
Phone: 215-625-9609 
This website offers options for children under the age of 19 from low-income families living in New York City to recieve health insurance.
Partnership for Prescription Assistance
Access to free or nearly free drugs directly from pharmaceutical company programs based on financial need.

Patient Access Network
Co-payment assistance for approved cancer medications for patients who qualify based on income.
Patient Advocate Foundation's Patient Services provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their illness. 
Phone: 800-532-5274
State Catastrophic Illness Coverage
State insurance may be available if your private insurance plan does not include catastrophic coverage. Ask your pediatric social worker to help you find out if your state has this program.
The Supplemental Security Income (SSI) program may provide some income for a child who is ill or has a handicap condition. Qualification is based on the parent’s income. SSI will also entitle your child to Medicaid. Check with your local Social Security Administration office for an application.
The federal telephone number is: 800-772-1213. 

 UnitedHealthcare Children’s Foundation
"The Foundation embraces and supports the concept of facilitating access to health-related services that have the potential to significantly enhance either the clinical condition or the quality of life of the child and that are not fully covered by the available commercial health benefit plan. The Foundation provides financial assistance toward the family's share of the cost of medical services. "

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