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Insurance and Payment Questions and Answers

Q. Why is it important to give The DIC all of my child’s insurance information?

A. In order to meet operating costs, we depend on parents and caregivers to provide us with all current insurance information so we can bill the insurance company for your child’s care.

Q. Why is it important to tell The Detroit Institute for Children that my child’s insurance has changed?

A. We need this information to properly bill your insurance company. Please do not delay giving us this information. If we are not able to bill your insurance company, you may be charged for your child’s treatment.

Q. If I have HMO insurance coverage, why must I bring a referral from my child’s Primary Care Doctor with me to my child’s appointment?

A. Your insurance company will not pay for your child’s visit if you do not have a referral from your HMO Primary Care Doctor. Certain HMO’s, such as; Coventry, Blue Care Network, and Great Lakes Health Plan, also require an authorization on the referral. Children who are covered by Medicaid HMO plans also need to bring a referral.

We will not provide services without a referral, or an authorization if one is required. It is important to note that you should not try to get your referral by telephone on the day of your appointment. Your Physician’s office may require 7 to 10 day notice.

Q. I have always had Medicaid for my child. Now we have an HMO. How did this happen if I did not ask Medicaid to change my child’s coverage?

A. You should check your Medicaid card every month to find out if your coverage has been changed to an HMO. You can choose which HMO will manage your child’s coverage if you respond when Medicaid asks you to select one.
If your current primary care doctor is not a participant with your new HMO, you must see a doctor within that HMO network before a referral will be given.  For questions on HMO Plans or covered services, please contact us at 313/832-1100 ext 256.

Q. What should I do if my child does not have insurance coverage, or has lost their private medical insurance?

A. You can call your local Health Department or you can use a computer and go to the http://www.michigan.gov/mdch web site and select Health Care Coverage, and it will give information on all state and federal plans along with printable brochures.

Q. What if I applied for state or federal insurance and my child is not eligible?

A. Unless other arrangements have been made, we must hold the parents or caregivers personally responsible for payment for their child’s care. The Detroit Institute for Children staff will work with the family to decide on a payment plan. Call us at 313-832-1100 to discuss this and other information.

Q. What if my benefits for the services that my child has been receiving are used up?

A. If you want to continue your child’s treatment and have used up all of your benefits, you may call us to make payment arrangements. This will require review and approval by Administration.

Q. My child is covered under a Master Medical Insurance policy. How should I make my insurance payments to The Detroit Institute for Children?

A. Families with Master Medical are required to sign over, or endorse, all insurance checks to The Detroit Institute for Children. The check was sent to pay what is owed to your child’s care. We also ask for the “Explanation of Benefits” that came with the check.
Unless other arrangements have been made, The Detroit Institute for Children may decide not to treat your child if you do not sign over the insurance payment check and give us the “Explanation of Benefits” as required.

Q. How will I know if my commercial insurance has paid my claims?

A. All patients with commercial insurance, including Blue Cross/Blue Shield, Blue Care Network and Federal Blue Cross will receive an Explanation of Benefits (EOB) by mail.  This is important information that will tell you if a claim was paid or denied. It will also let you know what your part is, such as a co- payment or part of your deductible.
It is your responsibility to know your insurance,  however, The DIC billing staff will be happy to assist you with questions about specific claims.