Navigating Insurance for Children with Special Needs

Load into the car, go to therapy, visit the doctor, battle insurance, repeat. Does that sound familiar? For many families, this busy agenda is a daily routine. Now imagine a schedule with fewer car rides and a little less time on hold with your insurance company.

VIVA Pediatrics meets the unique needs of North Texas families by providing in-home nursing and therapy services to children from birth to 21 years of age. Their expert team of healthcare professionals offers private duty nursing to medically fragile children, as well as speech therapy, physical therapy and occupational therapy.

By bringing this skilled help into your home, VIVA Pediatrics protects your children from exposure to additional germs outside of the home, with the added benefit of granting families a break from darting from appointment to appointment.

The team at VIVA Pediatrics is no stranger to the facts—they know firsthand that coordinating medical care across specialties is a huge undertaking. Throw in dealing with insurance and you’ve got yourself a full-time job. To help you navigate the overwhelming world of home health, VIVA Pediatrics shares expert tips on how to approach insurance.

Get the process started. Whether you use private insurance or a managed care organization, speak with your medical provider about what treatment plan is right for your child. The medical provider will determine the need for home health services based on the patient evaluation and diagnosis. From there, a home health clinician will assess the patient’s eligibility and create a custom care plan based on your child’s needs. The plan of care will then be authorized and signed by your child’s pediatrician and you, the parents, before being sent to your insurance company for approval.

Your child might be eligible for Medicaid. Round-the-clock or frequent in-home care can cause medical bills to land far above what most salaries can afford, and private insurance often doesn’t cover the full cost of care. While many people assume that their annual household income prevents their families from receiving Medicaid services, your child might be eligible for a Medicaid Waiver Program. Even if your family has private insurance through an employer, your medically fragile child might be qualified for enrollment based on their medical needs.

Go ahead and add your child to the waiver list. Texas currently offers 7 different Medicaid Waivers, each with its own waitlist. While the process to enroll in the program can involve some wait time, your child might be granted a speedier approval process based on their medical needs.