Preparing for the Financial Aspects of CHD

  • April 27, 2022

When a family learns that their child has a congenital heart defect, the financial aspect of that serious diagnosis is often the last thing on their minds. However, along with providing world-class pediatric cardiac care and treatment, Sibley Heart Center Cardiology walks with families every step of the way, including helping them to prepare financially.

“The first thing they should know is, similar to any time their child gets sick,” said Teresa Traugott, Senior Business Office Manager at Sibley Heart Center Cardiology. “Ask yourself, ‘What insurance do I have, what is my deductible, what will I owe and what are my options?’”

Some families have Medicaid, and some have excellent insurance, but few will leave the hospital with a zero balance. Some families have low-cost health insurance plans with deductibles as high as $10,000, which can be a heavy burden after a heart surgery and stay in the hospital.

“Ask questions up front if you can,” Traugott said. “Sometimes a parent gives birth to a child with health problems, and they don’t know what to ask or expect. But on return procedures and office visits, you can ask, ‘What am I going to owe?’”

Children’s Healthcare of Atlanta and Sibley Heart Center Cardiology offer generous financial assistance based on family size and percentage of the federal poverty level. Traugott said she encourages people with a large bill to proactively seek financial assistance. She also recommends getting in touch with a cardiology social worker, who can identify resources to help.

“The social worker can stretch your resources well beyond the bill itself,” Traugott said. “If we know what your situation is and what your worries are, we can best address them to make life a little easier for families. There is an awful lot of help out there, and people just don’t know it. Don’t be afraid to ask.”

Frequently asked questions:

How much will my child’s visit cost?

The cost depends on the services required to diagnose or treat your child’s condition. How much you pay for your child’s visit depends on your insurance plan, and most healthcare plans require a co-pay or an annual deductible be met.

How do I obtain an estimate?

If you have insurance, please check with your insurance carrier, or contact our Financial Counseling Team to help determine your out-of-pocket cost. If you are self-pay, we recommend you contact our Financial Counseling Team prior to your child’s visit to obtain an estimate.

Do I need to tell my insurance carrier I’m coming?

We accept most major insurances, however, if your plan has a set list of physicians you may visit, please confirm we are on the list. Keep in mind some insurance plans require pre-approval before a patient can be seen. The following insurance plans are examples of plans that require an approval before you arrive for your appointment: Kaiser, Tricare, Ambetter, Maestro. If your insurance card states, “Referral Required,” please contact your insurance carrier to obtain a referral.

What do the following key terms mean?

Allowed Amount. The amount your insurance carrier agrees to pay, the remaining balance will be adjusted.

Co-pay. A predetermined amount paid by a patient for receiving a healthcare service. This amount may vary depending on the specialty.

Co-Insurance. This is a generally a percentage of a medical charge that you pay, with the rest paid by your insurance.

Deductible. How much you pay before your insurance starts to cover your bill. This normally resets yearly.

Premium. The amount of money charged by your insurance company for the plan you have selected.


Some helpful online resources include:

 

For additional information from Sibley Heart Center Cardiology:

Foundations that provide financial assistance and/or resources:

  • Heartfelt Dreams Foundation
  • Harboring Hearts
  • Hopeful Hearts
  • Mended Little Hearts
  • Ansley’s Rainbow of Hope
  • Project Hope
  • Just Heart Foundation
  • Focus & Fragile
  • Children’s Medical Services
  • Brave Like Wyatt
  • CORE
  • Giving Kitchen

For more information about Sibley Heart Center Cardiology and our pediatric cardiology specialists, click here.