Chapter 7: Your Child's Health Plan

For more information about health insurance, paying for your child's health care, and public benefits, see:

• Health Care and State Agencies sections of the Family TIES Resource Directory.

• Your Guide to Managed Care in Massachusetts (2005)  file size 3MB

• Paying the Bills: Tips for Families on Financing Health Care for Children with Special Needs, available from New England SERVE. Order a free copy by calling 617-574-9493.

A Member Services Representative at the health plan can be very helpful in answering your questions.

Case management, also called care management, is offered through many health plans to help families access and coordinate services and benefits.

Mental health and substance abuse services are sometimes called behavioral health services. Some mental health services are paid for by most health plans. Different plans may have different mental health and substance abuse service benefits.

Prior authorization, also called prior approval, means getting permission from the health plan before your child uses a special service or kind of equipment.

If you disagree with a decision made by the health plan, the primary care provider may appeal to the plan.

At times you may not be satisfied with the care your child has received and may want to notify the health plan with your concerns.

If changes are made to your health insurance plan, learn as much as you can before the change.