Health Insurance Can Be Confusing!
When you’re choosing a doctor or hospital for your child, you want to make the right choice. To make sure the best care is available for your child, choose insurance coverage that includes Phoenix Children's Hospital and Phoenix Children’s Medical Group (PCMG) providers in the health plan’s provider network.
What should I look for in an insurance plan?
Insurance companies will provide the details of their coverage online and in their benefit plan description. If you get your insurance through your employer, the company will provide information about the coverage they provide and what the premium costs are. Here are some tips:
- Even if you have the same insurance company you’ve had in the past, their products may have changed. Many insurance companies are moving to “narrow networks,” meaning they provide a limited choice of providers in their network. A narrow network plan may have a lower premium but, ultimately, the total cost of care could be more if your child needs to see a specialist that is not included in your health plan’s network or if your child is hospitalized and the only place they can get the care they need is not in the network
- Check to see if your primary care provider (general pediatrician) for your child is in the network for the insurance plan you are considering.
- Make sure you understand the provisions (if any) for out-of-network benefits.
- If your child sees pediatric subspecialists for care, note the plan’s requirements for referrals and the coverage provided by your selected plan.
- Make your decision based on the total value of the plan, considering your family’s specific health care needs and usage pattern. For example, if your child has ongoing or chronic health concerns, you may want to consider a plan that may have a higher monthly premium but covers a a greater share of the health care costs through a lower deductible, co-insurance or co-payment.
What It Means
Premium – the regular payment you may (sometimes deducted from your paycheck) to pay for your enrollment in an insurance company’s health care coverage
Deductible - the amount of money you must pay before your insurance company begins covering part or all of your medical expenses. Check your insurance coverage details to confirm the amount of your deductible
Co-insurance - after you meet your deductible, co-insurance is a set percentage of the insured medical expenses that you may be required to pay. Check your insurance coverage details to confirm your co-insurance percentage.
Co-payment - a set payment you make every time you receive a medical service, according to your insurance coverage. Check your insurance coverage details to confirm the amount of your co-payment, which is due when you receive services.
Provider Network/In-network Provider – a list of health care providers, services or hospitals that have contracted with your insurance carrier to charge you a contracted rate for their services
Out-of-network – providers who are not contracted with your insurance carrier. If you see an out-of-network provider, your charges will be higher than in-network.