Published on August 13, 2015

Do your grandchildren have health insurance?Do your grandchildren have health insurance?

When my granddaughter was born at Cape Cod Hospital on Friday, May 15, our family’s joy quickly turned to fear when we realized she was struggling to breathe.

The Floating Hospital for Children at Tuft’s Medical Center in Boston immediately sent a neonatal team in a specially outfitted ambulance to pick her up. We found out the next day that she had suffered a stroke.

For the first couple of days we were in a state of shock, but on Monday morning I asked my husband to check with our insurance company to see what kind of out-of-pocket expenses we faced.

He called me back with the news that the baby had no insurance. She had fallen through a loophole in the Affordable Care Act.

None of us had even considered this possibility.

The health law allows young adults to remain on their parent’s insurance plans until the age of 26. The intent was to provide coverage to as many young people as possible with the least financial burden as they were beginning their own careers.

Our daughter, who is 22, is on our insurance, our son-in-law is covered by his parents’ plan.

But neither insurance policy covers grandchildren.

“Newborns are hard because you can’t really predict when services are going to be needed,” says Tracey Carey, supervisor of financial counseling at Cape Cod Healthcare. “We’re only verifying the coverage for that one single patient.”

Our daughter was fortunate. A Tuft’s financial counselor found an affordable plan for our granddaughter. The plan was retroactive ten days prior to application. My daughter applied just in time for her daughter to be covered.

Many people may not know that state law requires all hospitals to offer financial counseling services. Cape Cod Hospital has four financial counselors; Falmouth Hospital has two. The counselors’ job is multifold.

“What we try to focus on now is really educating patients on what their out-of-pocket expenses would be before the service,” Carey says. “We’re trying really hard to come up with creative ways so that it’s not a huge surprise.”

Anyone who has a procedure scheduled at the hospital, either inpatient or outpatient, or who enters the Emergency Center goes on a work list. The financial counselors then use a specialized search engine to see if the patients have health coverage.

Patients whose insurance companies don’t use the search engine can provide that information themselves.

If they discover the patient doesn’t have any insurance, the financial counselors help them fill out an application. Time is of the essence because most of the plans have a short window. But once the application is filed, coverage begins that day.

“Most people qualify for one of the state offered plans,” says Carey. “More times than not, we actually file the application on behalf of the patient.”

And you don’t have to be a patient of Cape Cod Healthcare to use this service, Carey says. It’s open to the entire community.

“Our goal is to ensure that everybody has comprehensive healthcare coverage,” she says.

Uninsured patients can call 508-862-7019 at Cape Cod Hospital and 508-495-7156 at Falmouth Hospital to set up an appointment with a financial counselor.