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Department of Human Services
James T. Dimas, Secretary-designate
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Service Coordination Public and Private Insurance Use Determination
Families whose children are enrolled under private insurance plans are required to use their child's benefits to assist in meeting the costs of covered Early Intervention services and devices unless an insurance exemption has been approved.
The family, in conjunction with the CFC, and in cooperation with their insurance company and the service provider, will determine insurance benefits. The provider shall contact the insurance carrier for verification of benefits and should send the verification in the form of a denied claim or statement of non-coverage under the insurance plan to the CBO as part of the billing process. One or more of the following items must be obtained by the CFC as documentation if the service is not covered:
Applicable pages from the plan that clearly state that the service is not covered;
Notes from conversation(s), with the name(s) of the insurance company contact, phone number(s) and date(s) of contact, by CFC Manager and/or service coordinator confirming denial of the service; and/or
Written response or denial from insurance company
All Early Intervention service providers are required to bill private insurance prior to billing the CBO unless an exemption has been approved. The only exceptions are Developmental Therapists, Interpreters, Deaf Mentors, and Physicians providing only medical diagnostics, Transporters, and Parent Liaisons.
Families may request exemption from private insurance for one or more services if such use would put the family at material risk of losing their coverage as specified on the Insurance Exemption Request form.
Private insurance plan/policy covering child was purchased individually by a head of household not eligible for group medical insurance.
Child's private insurance plan/policy has lifetime cap for one or more types of early intervention services which could be exhausted during the IFSP period based on the estimated cost of the Early Intervention services.
Service coordinators are required to enter private insurance information on Cornerstone for covered EI eligible children.
Service coordinators are required to enter Medicaid or KidCare (State Child Health Insurance Program or other public insurance plan) recipient identification numbers on Cornerstone for covered EI eligible children.
Regional intake entities are required to apply to the Illinois Department of Public Aid to become KidCare Applicant agents.
Families determined eligible through use of the Screening Device are required to apply for benefits through Medicaid/KidCare in order to enroll and remain eligible for Early Intervention services.
As payer of last resort, all other resources must be maximized to cover the costs of Early Intervention services prior to utilizing state and federal appropriations for Early Intervention services.
State of Illinois
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