CoverKids Changes

This October 2013 and again in January 2014, the State of Tennessee is changing some elements of CoverKids. We want you to stay up-to-date with this information if it pertains to your family.

What’s changing about CoverKids?

Two things are changing:

  1. In October 2013, all kids with CoverKids are moving from BlueCross BlueShield’s network S to the TennCare Select network.
  2. In January 2014, about 1/3 of kids with CoverKids will be moved to a TennCare plan.

So in October, my child with CoverKids will have TennCare?

No.   Kids with CoverKids will still have the CoverKids benefit package but the network will change to the TennCare Select network.   (We agree this is a very confusing change.)   Here’s what will change:

  • Your choice of doctors and service providers will be more restricted.  
  • Your doctors will be paid about 30% less for providing the same services as before.

Most other things from the patient’s point of view will stay the same:

  • You will still have the same benefit package – checkups, sick visits, hospital care, shots, medications, etc. will be the same.
  • You’ll have the same co-pays as before.

Will Plateau Pediatrics continue to take my insurance?

Yes.  All 5 providers at Plateau Pediatrics are in-network with TennCare Select and take all the TennCare plans.

Will my child’s other doctors still take my insurance?

While many of the specialists, dentists, therapists, etc. that our patients see also participate in the TennCare Select network, many of them do not.  We know that some of our patients who have been seeing a specialist will have to switch specialists, because their current specialist does not take TennCare Select.  If you are not sure whether your child’s specialists or other providers take TennCare Select, we encourage you to contact their office as soon as possible.  If you need new specialists, please let us know soon – establishing care with a new specialist can sometimes take months. 

What happens in January?

In January, some families with lower incomes will be moved from CoverKids to a TennCare plan.  Unlike the October change, it’s not just a network change – you will no longer be part of the CoverKids plan, and you will have TennCare.

How do I know whether the January change will apply to me?

Families whose incomes fall below a certain level will automatically be switched.  In general, these will be kids ages 6-18 whose family incomes are below $1700/month (for a single parent with one child) to below $4400/month (for a family of 8).

The January change is a result of the Affordable Care Act (“Obamacare”) and does not have anything to do with decisions made by the State of Tennessee.  

If my child is switched to TennCare, will he/she get TennCare Select too?

No.  Your child will be randomly assigned to one of the regional TennCare plans.  If you live in middle Tennessee (including Cumberland County), you will be assigned to Amerigroup or United Healthcare Community Plan.   If you live in east Tennessee (including Bledsoe County), you will be assigned to BlueCare or United Healthcare Community Plan.

After being assigned to one of these plans, you can switch plans if you ask within 45 days of your reassignment.    In general, we recommend United Healthcare Community Plan -- they are in network with nearly all the East Tennessee Children’s Hospital (Knoxville) specialists, as well as Vanderbilt and TC Thompson.  Amerigroup only offers specialists in Nashville.

If you would like to switch plans, please contact our office.

What if I have more questions?

We want you to understand your insurance benefits.  Most importantly, we want your kids to be able to transition smoothly to their new plan, with no interruptions in their health care.  You can contact our billing department at (931) 707-8700, extension 4.

You can also contact TennCare/CoverKids at 1-800-924-7141.