Q & A: CHIP, From a Local Mom’s Perspective

Stacy (name has been changed to protect privacy) lives in the greater Austin area and has 2 children: a 3-year old and a 9-month old infant. Both her children have been covered by CHIP for several months now, through the Seton CHIP program. Here are some questions I asked about her experience with the program, and her answers:

Q:  How did you first hear about CHIP?

A:  I guess I always sort of knew about it, because I worked at a doctor’s office in the past. But I didn’t consider applying until I talked to a friend whose two children were on CHIP. I decided to apply then. I first applied when I was pregnant with my second child, but was turned down because our family made too much money. I continued to apply several more times after he was born, and finally began receiving coverage.

Q:  Did your children have health insurance before you got CHIP?

A:  Yes, they were on an independent insurance program with me (Blue Cross, Blue Shield), but had to be off of it for 90 days before CHIP would cover them. If we had been paying around $1,000 in order to be insured through my husband’s employer, CHIP would have considered us an emergency case and immediately begun coverage. But since we weren’t, the kids had to be uninsured for about three months.

Q:  When did you first begin receiving coverage?

A:  After our second child was born. It’s been about three months.

Q:  How did you apply?

A:  We applied online, and also talked to someone over the phone during the application process.

Q:  How easy or difficult was it to apply?

A:  The paperwork was easy to fill out, but we had to reapply several times because they kept finding these glitches and would just drop our applications without telling us. I had first applied when I was pregnant with my second child, but we didn't qualify then. We would have to wait weeks and sometimes months to hear anything. I had to call them over and over again to get any sort of answer.

Q:  How long did you wait to find out if you would be covered?

A:  It was months before I was finally able to get any coverage.

Q:  How much does CHIP cover for prescriptions? Doctor’s visits? Hospital visits?

A:  For prescriptions, there’s a small copay of $7. For office visits, we pay $12 – unless it’s a wellness check-up, and then it’s free. The copays on office visits actually just went up, from $7 to $12, which is sort of annoying. But that’s still really cheap! We haven’t had to go to the hospital since we’ve been on CHIP, so I’m not sure how much our copay would be there. Since we’re on the Seton CHIP program, I think it would be fully covered, as long as we went to a hospital in the Seton network.

Q:  What service do you utilize most through your CHIP coverage?

A:  Definitely doctor’s visits. Max (the younger child) has had a lot of ear infections, so there have been periods of times when we’ve had to go see a doctor once every week. He just had to have tubes put in his ears, and we haven’t gotten the bills for that yet, so I’m not sure how much that’s going to cost. Up front, we just had to pay the $12 copay to see a specialist.

Q:  What would you do if you didn’t qualify for or were cut from CHIP?

A:  We would go back on independent insurance, which covers pretty much nothing. But the kids have to have insurance.

Q:  Has your experience having your children on CHIP been positive? Negative? A combination of the two?

A:  Once we were finally approved, it has been awesome! They even retroactively paid for a doctor’s visit that we had to go to before we were covered by CHIP, which was so great. It was just the initial application process that was a bit difficult.

Q:  Do you have anything else to say about CHIP?

A:  It’s great! It’s tons cheaper than regular insurance! I wish I qualified to be covered by the equivalent (Medicaid), but I guess it’s a blessing that we make a little too much income for me to be on that.