Understanding your coverage
The services covered by your health insurance and the amount you will owe depend on the plan you have. There are a wide range of plans and coverage.
Your cost is determined by your plan benefits such as your copay, coinsurance, individual and family deductible and out-of-pocket maximum amounts.
Some plans consider Children’s Hospital of Wisconsin providers, services and locations to be out-of-network. This means you may be required to pay a larger portion of the bill. It also can mean your health insurance plan won’t cover any services provided by Children’s.
You will want to understand what is covered when you are selecting a health insurance plan. You also should confirm your coverage before receiving care, except in an emergency.
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Ask the right questions
The first step is to determine if Children’s services are covered by your health insurance plan. But that isn’t enough. It also is important to understand the level of your coverage. You can do this by reviewing your health insurance plan benefits or talking with your health insurance company. Some key questions are:
- Which services are covered? Examples include primary care (pediatrician or family practice doctor), urgent care, specialty care (such as a pediatric dermatologist or cardiologist), lab tests, imaging studies (such as X-rays) and hospital care.
- Which locations are covered? Examples include primary care offices, urgent care clinics, specialty clinics, outpatient surgery centers and hospitals.
- Which providers are covered? Examples include individual doctors or advanced practice nurses.
- Is Children’s in network or out-of-network? Out-of-network services may be covered at a lower level or not covered at all.
- Do I have a copay? If so, what is it?
- What is my coinsurance percentage?
- What are my individual and family deductibles? How much of these deductibles have I met for the year?
- What are my individual and family out-of-pocket maximums for the year?
Our Financial Counseling team can provide guidance. They are available 7 a.m. to 5:30 p.m. Monday through Friday at (414) 266-5700 or