Navigating Healthcare for the NICU

Be Informed on NICU Healthcare Services

We’ve team up with Hand to Hold® to offer some helpful NICU healthcare tips. 

The healthcare system in the U.S. can be complicated. When your baby has a NICU stay, you have to learn how to navigate it.

Dealing with insurance, hospitals, and specialists can be frustrating and confusing, but with some practice, you will get a hold on it.

Finding Health Insurance

You need to find health insurance that works for your family. To shop for coverage, visit healthcare.gov.

Medicaid & CHIP

For babies in the NICU, Medicaid covers some or all of their care. Medicaid is a government insurance program for people with disabilities and lower income families. Children’s Health Insurance Program (CHIP) provides affordable, high-quality medical coverage for children. Medicaid and CHIP both place a high priority on early medical care and intervention. Medicaid covers many services that some private insurance companies don’t. Even if you have private health insurance, Medicaid is an excellent secondary insurance plan for your baby.

Private Insurance

Many families use a combination of public and private insurance to cover the cost of the NICU and their baby’s follow-up care. You may have private insurance that you have purchased on your own or through your employer. Every insurance plan has its own rules for paying for services, and every provider bills their patients differently, depending on the rates they have negotiated with insurance companies. Call your insurance provider and visit their website to learn about your plan’s coverage and limitations. Ask about your co-pays and deductibles. These are the portions of your family’s medical bills that you will be expected to pay out of pocket.

Choosing Doctors

Your insurance plan will have guidelines for which doctors, therapists, clinics, and hospitals are in-network that you can go to for care. If you want to use providers who are not on your plan or are out of network, you may pay more. But there are exceptions. Sometimes your insurance plan will pay for out-of-network providers if there are no doctors on your plan who provide the specialized care your baby needs.

What to Look For

The most important thing about choosing a doctor for your baby is finding someone you can get to know and trust. Ask if they have experience working with NICU graduates. Then ask how you will work together to take care of your baby’s unique health and developmental needs.

Finding a Medical home

A medical home is not a house, a hospital, or an office. It is an idea about the best way to meet all your child’s medical and developmental needs. When you have a medical home, it means that your baby’s care is guided by the belief that they aren’t just a patient. They are part of a family and community that work together to care for them. Ask one of your baby’s doctors if they will be your medical home. They will help you gather information from all your baby’s providers and caregivers so that everyone can work together as a team.

Care Coordination

If your baby sees multiple doctors and specialists, everyone needs to know what everyone else is doing. That includes your baby’s pharmacist. By working together and looking at all the relevant information, you can make better decisions, avoid duplicate tests or services, and minimize the risk of using the wrong medications or interventions.

Case Management

One way to coordinate care is to use case management services. Many insurance providers, including CHIP and Medicaid, can connect you with a professional who will help you manage your child’s care. Case managers help you understand your baby’s insurance benefits and assist you when you need approval or prior authorization for services, specialists, and equipment. Your case manager will learn about your baby’s special medical needs and help you get the most out of your insurance benefits.

About Hand to Hold

Hand to Hold is a national nonprofit 501(c)(3) that provides early-intervention mental health support, educational resources and community before, during and after a NICU stay. They are boldly removing barriers for all NICU parents to receive emotional support at no cost.

Click here to download the Navigating Healthcare PDF.