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An announcement from The Executive Director

Thank you for visiting PTI Nebraska and the Family to Family Health Information Center.  Our website is currently under construction and so some of the links on the site may be unusable or unavailable for a short time. 

We hope you and your family are staying well during the COVID-19 crisis. These are troubling times for all of us, and we wanted to provide some level of assurance that we will continue making every effort to provide you and your family professional services under these new circumstances.

You should know that our priority is the health and safety of you, our families and our employees. PTI Staff are working from home to avoid person-to-person contact and we will seek alternatives in all situations. The PTI office location remains closed indefinitely.  In addition, we are following protocols and guidance from the Centers for Disease Control and Prevention (CDC) and the Department of Education.  Please visit the COVID-19 tab on the website to find additional resources.

At PTI Nebraska we are committed to promoting inclusion, especially for children who have disabilities, and we want to acknowledge the events that have occurred recently in Minneapolis with the tragic death of George Floyd that has led to protests in Omaha, NE and around the country. Our deepest sympathies go out to everyone who has been impacted by the recent traumatic events, which also includes the family and friends of James Scurlock.

Our hearts are sad. We feel broken and we know we are not alone because our entire country is deeply hurting right now. We look at our children and wonder how are we going to all come together and make things better for them? Because we have to – every single child deserves better than this.

We stand in solidarity with everyone who is peacefully speaking out against injustice and inequality in all forms. We are against every kind of discrimination.

We stand with everyone who wants positive change and a society that is led by compassion and understanding, where diversity is celebrated and people are valued, respected, and accepted for who they are. We stand with everyone who wants social justice, inclusion, and equity for all children in our communities and schools.

We know that many children might be experiencing increased anxiety and depression by the traumatic events that have taken place recently. Although we cannot take away any pain, confusion, or fear children might be feeling, we can offer resources to help parents and families navigate the important discussions they are having with their children about racism, oppression, and hate, as well as discussing all of the big feelings that children might be having right now.

Parents/families – We are all in this together. For anyone who is hurting right now, we hope for healing and a better tomorrow.

We will continue to be available to consult with you over the phone or email.  Please contact us at 402-346-0525 and we will return your call as soon as possible. You can also email us at info@pti-nebraska.org.  Additionally, you can find us on Facebook @PTINebraska for the latest information on webinars and virtual trainings and events. Thank you,

Sincerely,

Mike Tufte

Executive Director

PTI Nebraska

Family Voices. …keeping families at the center of children’s health care.

Affordable Care Act (ACA):

What Families Can Do to Avoid “Surprise” Medical Bills?

Most families are familiar with managed care and understand that they have better health care coverage if they stay within their plan’s network. However, even when families go to network hospitals, they are sometimes hit with surprise medical bills.

 

How Does This Happen?

Even if a hospital is in a family’s plan network, not all of the providers who provide services at the hospital may be in the network. It is important that parents know if individual doctors are also participating in the plan. This can be important to know for routine visits to a children’s hospital as well as for in-patient or emergency care.

 

In-Patient Care

Parents may have been diligent in finding both a hospital and also a provider who works there in their plan’s network. However, if their child needs surgery or other care, it is possible that the anesthesiologist, for example, may not be participating in their plan. Then the family receives an “out-of-network” bill.

 

Emergency Care

The situation is even more difficult during an emergency. Families may have to go to the nearest hospital or perhaps get admitted or transferred to a hospital that may be out-of-network.

 

“Because regulators rely heavily on complaints as an indicator of potential problems with a health plan’s network, it is imperative that consumers are aware of the ability to file complaints with the DOI and the process for doing so.”1

What Can Families Do?

  • Use in-network hospitals.
  • For medical appointments, check that the providers at the hospital are also in-network.
  • If using Medicaid as secondary payor, get an out-of-state authorization. NOTE: Even non-participating providers can bill Medicaid out-of-network as secondary to private insurance.
  • File a complaint, see https://consumersunion.org/insurance-complaint-tool/.

Families need to be vigilant about using in-network providers to ensure that their insurance will cover medical services. Plans should make information on network providers “transparent”, or disclose estimated costs out-of-network, so families don’t get unexpected medical bills. Some states have proposed protections, including for self-funded/self-insured plans. For more information on what families and advocates can do, see Resources below.

 

RESOURCES

Ø Balance Billing: How Are States Protecting Consumers from Unexpected Charges? http://www.rwjf.org/en/library/research/2015/06/balance-billing–how-are-states-protecting-consumers-from-unexpe.html?cid=xsh_rwjf_tw

 

Resources from Consumers Union Health Care Value Hub:

ØWebinar Recording from Consumers Union Health Care Value Hub: Addressing Surprise Medical Bills: New Research and State Approaches http://www.healthcarevaluehub.org/files/9514/3386/8195/June_5_Webinar_-_Surprise_Medical_Bills.pdf

ØSurprise Medical Bills: Grid of State Legislative Solutions

http://www.healthcarevaluehub.org/files/7714/3351/9223/Hub_Surprise_Med_Bills_Grid_of_State_Legislative_Solutins.pdf

ØInsurance Complaint Tool: https://consumersunion.org/insurance-complaint-tool/

 

This tip sheet is based on an ACA blog authored by Lauren Agoratus, M.A. Lauren is the parent of a child with multiple disabilities who serves as the Coordinator for Family Voices-NJ and as the southern coordinator in her the New Jersey Family-to-Family Health Information Center, both housed at the Statewide Parent Advocacy Network (SPAN) at www.spanadvocacy.org. More of Lauren’s tips about the ACA can be found on the website of the Family Voices National Center for Family/Professional Partnerships: http://www.fv-ncfpp.org/.

 

 

1 NAIC Consumer Representatives Report, Ensuring Consumers’ Access to Care: Network Adequacy State Insurance Survey Findings & Recommendations for Regulatory Reforms in a Changing Insurance Market (November 2014). http://www.naic.org/documents/committees_conliaison_network_adequacy_report.pdf