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About Health Insurance Plans

Health insurance is insurance that covers medical expenses or healthcare services. It can be managed by a private organization or a government agency. Your child's health insurance will cover a lot of the costs associated with his or her treatment.

If you have questions about your plan, call a member services representative. You will find the plan's phone number and your child's membership number on his or her insurance card. To make your conversation as effective as possible, write down your questions before you make the call.

Calling a member services representative

A member services representative at your child's health plan can help you by answering questions about:

  • Eligibility, benefit coverage, and enrollment in the health plan
  • How to access other services, such as case management
  • How to find a primary care provider (PCP) or specialty providers in the plan
  • How to change your child's PCP
  • How the prior authorization process works
  • What to do if you have a complaint or grievance
  • What to do if you disagree with a decision made by the health plan and you want to appeal the decision
  • Coverage for services your child receives out of state
  • Billing

This information is provided in part by the Division of Perinatal, Early Childhood, and Special Health Needs within the Massachusetts Department of Public Health and mass.gov.

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