Asthma and the Health Care System

Parents of children with chronic diseases know all tooprivate insurance through your employer, you need
well, there's more to caring for a child than givingto explore what it covers. Inpatient (in-hospital) and
medicine and getting to doctors appointments.outpatient (office) benefits may be treated
There's also a sea of bureaucracy the "health caredifferently and may include copays and deductibles
system" of insurance forms, referrals, specialists, bills,that come out of your pocket before the insurance
copays, deductibles, prescriptions, medical devices.coverage starts to pay. Some insurance plans provide
Caring for a child with asthma may sometimes feelfull payment only to providers who are within the
like a journey across unfamiliar waters. Your primaryplan's own "network." If this is the case, it's important
care provider's office may serve as a home base,to be sure that the network includes your child's
but other important ports of call may includeprimary care doctor or pediatrician, nurse practitioner,
subspecialists, visiting nurses, medical supplyand other health care professionals. A referral from
companies, and other providers. Unfortunately, theyour primary care provider may be needed for the
coordinates for this journey are not mapped outinsurance plan to cover fully any specialists, such as
clearly for you in advance. Our health care system isallergy or pulmonary doctors. With the increasing
complex and ever changing. Financial and bureaucraticcosts of medicines, most insurance companies have
obstacles still prevent many children from receivingcut back on prescription plans. Many plans include
the care they need.Social workers can help familiescopays, prior authorization, or require the use of a
work through these challenges. You are fortunate if amail order prescription company. Generic forms of
social worker is playing an active role on your child'ssome asthma medicines are available and may result
team. If not, an experienced social worker hasin lower costs if prescribed by your doctor or nurse
contributed information to this topic that will give youpractitioner. By and large, generic drugs for asthma
insight into successfully navigating the health carework just as well as name brands. If your insurance
system. You can use this information to help create adoes not cover prescriptions, there are other options
team that includes your child's doctor and otherto consider. Some pharmaceutical companies offer
health care professionals. Parents should not have toassistance plans; information can be obtained by
carry the burden alone. Private Healthcontacting the individual company directly. Clinical
InsuranceAsthma care and medicines are expensive,research trials also will sometimes cover the cost of
and obtaining the right health insurance is anmedicines. Information about clinical trials can be
important first step in accessing the health careobtained through drug companies, your physician, or
system. Recent changes in the law provide thethrough an Internet site set up by the National
opportunity for virtually every child in every state toInstitutes of Health ( Durable medical equipment, such
qualify for some form of health insurance. The rulesas nebulizers and other home care needs, are
and steps involved are complex, however, and maycovered differently by insurance plans. Some forms
leave many gaps in the care that is provided. Goneof equipment, such as spacers, can be ordered at
are the days when parents could assume that anylow cost from organizations such as the Allergy &
type of health insurance would pay for all the careAsthma Network: Mothers of Asthmatics ( or
that a child with asthma requires. If your child has1-800-878-4403 ).