Insurance & Financial Questions

Parenting A Child With Special Needs, Continued

So now you have a better understanding of your child’s needs and those needs may be really complex (an explanation of different medical professionals for special needs children can be found here.  How are you going to pay for all of these services?  As previously mentioned, early intervention services are provided to all Pennsylvania families at no cost.  However, private therapies, as well as medical care can add up quickly.


If you have private insurance through an employer, you can call Customer Care and inform them that you have a child with special needs and require a case manager.  Your insurance case manager will help you process insurance claims, identify in-network providers, and in some cases, help make special reimbursement arrangements to minimize your out of pocket costs when using an out of network provider.  Even with a case manager, it is important to understand your health insurance plan and basic terms. This will help you catch mistakes and advocate for yourself. Believe me, insurance companies aren’t keen on catching billing errors that happen to be in their favor.  Here is a great primer.  


We are fortunate that the State of Pennsylvania recognizes the financial burden borne by families with special needs children.  As such, we have “wrap-around” insurance options here. Your household income level does not exclude you from this program. Wrap around insurance picks up the cost of medical care that your primary insurance does not cover (and often covers certain services or items that many insurance plans won’t, like diapers).  It cannot be used alone. It is funded through Medicaid and has specific requirements based on your child’s diagnosis. You can find a step-by-step guide here.  


Once you submit your application and are notified that you qualify, you pick out an insurance management organization (ex. Keystone First, United Healthcare, Aetna Health Partners).  Each network is slightly different, so make sure that your child’s regular providers accept the plan you choose. We received great guidance on this topic from the social work team at Children’s Hospital of Philadelphia.  Don’t be shy about reaching out to your providers and asking for their recommendation.


It is possible that your child has a disability that qualifies for some supplemental income through the Social Security Insurance (SSI) program.  The eligibility requirements for SSI are very strict, require substantial documentation, and the qualification process can take many months. Additionally, there are income restrictions and specific formulas that are used to determine financial qualification for the program.  It is advised to consult an attorney who is familiar with special needs benefits before embarking on this complicated process. You can find a step-by-step guide for Social Security disability payments here.