FAQs: Insurance, Copays, And Referrals - Children's Hospital Boston

OrthoTimes Exceptional Care, Exceptional Service
Vol
Children’s Ranked Number # 1 in Orthopaedic Care
Children’s Hospital Boston has been ranked first in Heart and
Heart Surgery, Neurology and Neurosurgery and Orthopaedics in the
U.S. News Media Group’s 2009 edition of America’s Best Children’s
Hospitals featured in the August issue of U.S. News and World Report.
Children’s Hospital Boston is one of only two hospitals to rank
in the top five in all 10 specialties. Children’s Hospital Boston ranks:
second in Cancer, Urology, Diabetes and Endocrine Disorders; third
in Digestive Disorders and Neonatal Care; fourth in Respiratory Disorders;
and fifth in Kidney Disorders. Unlike the rankings in previous
years, this edition does not rank the overall institutions, instead it
identifies and honor roll of the 10 hospitals that rank in all 10 specialties.
“We’re honored by the rankings, but also recognize that we must
continue to challenge ourselves to ensure that our patients and families
receive the best quality care and service possible,” says James Mandell,
MD, CEO of Children’s Hospital Boston.
According to U.S. News, the purpose of the “America’s Best Children’s
Hospitals” issue is to assist consumers in identifying medical
institutions known to demonstrate the highest level of expertise
in diagnosing, treating, or managing difficult medical conditions.
“Children’s Hospital Boston is a perennial leader because of the
unwavering commitment to excellence from our caregivers, researchers,
employees and volunteers,” says Sandra Fenwick, President and
COO of Children’s Hospital Boston.
The methodology behind this year’s rankings weighed a threepart
blend of reputation, outcome, and care-related measures
such as nursing care, advanced technology, credentialing,
and other factors. The hospitals were judged based on a
combination of opinions from pediatric specialists about the
hospitals they would recommend for the sickest children
and data gathered in a 65-page survey covering important
medical information ranging from surgical death rates to
Inside
Issue
US NEWS SURVEY RESULTS
CHILDREN AND BACKPACKS KID’S CORNER
FAQs: INSURANCE SATELLITE CORNER
SPENCER’S TREE FORT ORTHO NEWS
15 Oct 2009
whether pediatric anesthesiologists and
other sub specialists are on the staff. A
detailed description of the methodology
can be found at www.usnews.com/
childrenshospitals.
Ranking-eligible facilities were
largely drawn from two membership
categories of the National Association
of Children’s Hospitals and Related Institutions
(NACHRI): freestanding children’s
hospitals, or “hospitals within a hospital” (large,
multidisciplinary pediatric departments within a medical center).
Several non-NACHRI members were added because of known expertise
or at the recommendation of experts. Of the 160 children’s
hospitals invited to complete the 65-page survey, 98 responded.
The survey was created and administered by RTI International, the
same respected research organization that collects the data and
oversees the methodology behind the adult Best Hospitals rankings.

Children & Backpacks | Daniel Hedequist, MD
The presence of back pain or spinal deformity are the two
most common reasons patients are referred to the spine program
at Children’s. One of the most frequently asked questions relate
to the use of backpacks at school and any cause and
effect that they may have on spinal
conditions. Large and
heavy backpacks seem to
be a more recent phenomena
related to less
school lockers, larger
textbooks, and less
time between classes
given in order to
unload books at
the locker.
The use of
heavy backpacks
will certainly cause
children to droop at
the shoulders, bend
improperly at the
waist, or list forward
to one side. These
postural changes,
while not permanent,
are clearly
associated with an
FAQs: Insurance, Copays, and Referrals | Matthew White
I have an insurance card, does this guarantee coverage?
No. It is the responsibility of the insured to make sure their coverage
is up to date and active. Call your insurance company if you
have questions about your coverage.
Do I have a copayment?
It depends. It is important to bring your insurance card with you to
all appointments. The amount of the copayment listed for Specialist
will be your amount for a visit with our Orthopaedic specialists. If
no tier for specialist level is listed, the amount listed for an Office
Visit will be used.
When do I pay my copayment? Can I be billed for it?
Children’s policy requires all copayments to be paid at the time
of service. Orthopaedics accepts cash, personal check, Visa, and
MasterCard as forms of payment.
Why do I need a referral?
If your insurance only covers in-network providers, such as with an
HMO, often times seeing a specialist at Children’s requires a referral
from your primary care physician to be covered by your insurance.
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increase in back pain in children. In a recent study, up to 46% of
children complained of back pain with the use of their school
backpack. Risk factors included: heavier backpacks, improper fitting
packs, prolonged carrying of backpacks, and poorly fitting
backpacks.
In order to prevent some of these backpack related postural
changes and episodes of back pain there are some steps that families
can take. First, when shopping for a backpack studies have shown that
in the short term, children will opt for a more cosmetically appealing
backpack. However, the same group of children when forced to try out
different packs for a week will inevitably pick the most comfortable
and efficient packs over the trendier packs. We recommend packs that
have dual shoulder straps and a pad that fits against the back. If at all
possible a waist strap should be present in order to stabilize the load.
The backpack should also be optimally sized and fit for a child’s age.
A maximum of fifteen percent of your body weight should
go into your backpack. If your load exceeds this, some objects
should be placed into your locker or carried in your arms. As a rule,
if a child has to move forward or bend forward in order to carry
the pack then it is probably overloaded. Proper lifting techniques
are also important: face the pack, bend at the knees and check
the weight of the pack, then apply one shoulder strap at a time.
Improving the fit of a backpack, minimizing the weight, and
using proper lifting and carrying techniques should help alleviate
any discomfort associated with backpack wear. Any questions or
issues related to back pain or your backpack should be mentioned
at your visit with the doctor.
How do I get a referral? Where do I send it?
Call your primary care physician (PCP). They can fax it directly to
the Department of Orthopaedics at 617-730-0456.
I’m not sure if I have an HMO or PPO. How do I know?
Look on the front of your insurance card. It may say HMO, PPO,
Managed Care, or one of several other options. For questions
regarding your coverage, call your insurance provider.
I have Network Health and need a prior authorization for my
visit. Who do I call?
You may call Network Health or your primary care physician for
authorization. Network Health requires authorization to visit Orthopaedics
at Children’s prior to scheduling an appointment, so
it is important to contact them before you call to schedule an
appointment with us. This will save you a lot of time.
My insurance coverage and/or policy has changed. How do I
update this with Children’s?
You may update your information at check-in, or, to expedite your
visit, you may call ahead to the Patient Access Center at 617-355-7906.

Spencer’s Tree Fort | Daniel Piersa
Spencer Merrill is an 11 year old boy
who has been coming to the Department of
Orthopaedic Surgery at Children’s Hospital
Boston for about 10 years. Spencer has Spinal
Muscular Atrophy.
According to www.fsma.org, Spinal Muscular
Atrophy (SMA), is a motor neuron disease.
The motor neurons affect the voluntary
muscles that are used for activities such as
crawling, walking, head and neck control,
and swallowing. Intellectual activity is normal
in people with SMA and it is often observed
that they are unusually bright and sociable.
Approximately, 1 in 6,000 babies born are
affected.
Spencer’s family recently applied to
the Make-A-Wish foundation (www.wish.
org), and the foundation awarded Spencer
a wish. Make-A-Wish foundation helps children’s
wishes come true. Most children wish for a trip to Disney
or to meet their favorite Red Sox player, but Spencer wished for
something different. In fact, Make-A-Wish foundation awarded
Spencer’s wish as the most imaginative wish in the state of New
Hampshire.
What did Spencer wish for? Well, at first he wanted a Helper
Monkey, but those are only available for adults. So Spencer wished
for the next best thing, a tree fort. Spencer’s family saw a wheel
chair accessible tree fort 3-4 years ago at the Crotchet Mountain
Rehab Center in New Hampshire. Spencer wanted his own.
The tree fort at Crotchet Mountain was built by a Vermont
based company who also built Spencer’s tree fort. The tree fort
at Spencer’s house stands 6 feet off the ground, it measures 12x14
Satellite Corner | Brad Herrick
Orthopaedic Surgery has been a consummate department at
the main campus of Children’s Hospital Boston since the hospital’s
inception 140 years ago. Within the past two decades, the Department
of Orthopaedic Surgery extended its services and opened its
doors in several communities in eastern Massachusetts, in order to
provide the same great Children’s care and attention that patients
and families expect.
At Children’s Hospital Boston at Waltham, for example,
many of the orthopaedic providers hold the same outpatient clinics
that they do in Boston. Physicians specializing in upper extremity,
lower extremity, hip, spine, and other orthopaedic problems
all see patients here. The Waltham satellite also offers imaging
(X-ray, MRI, CT, nuclear medicine), lab, and physical/occupational
therapy services to supplement the care provided by the physicians.
Waltham has 6 operating rooms with 11 overnight surgical beds.
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feet with a 3x14 foot deck. It is wheel chair accessible and is built
into a real oak tree. The tree fort is wired with electricity, cable,
and internet. It has a flat screen TV, a poker table, and a ceiling fan.
I asked Spencer what his favorite part of the tree fort was and
he said, “The mini fridge.” Inside the mini fridge, Spencer keeps
juices and sodas. He also likes to play poker and Xbox on the flat
screen with his friends. His favorite game is Call of Duty (he has
every one). I asked Spencer if he still wished for the monkey and
he said, “No way!”
Spencer and his family would like to thank Make-A-Wish and
the Department of Orthopaedic Surgery. Spencer wanted to let
everyone know that he plans on spending as much time this summer
in the tree fort with his friends.
Thanks Spencer, you inspire us all here at Children’s.
Children’s Hospital Boston at Lexington also has several of
the same orthopaedic physicians whom you’d see in Boston. The
Lexington satellite has a radiology department (X-ray) as well as
physical/occupational therapy services. The Lexington facility is
on Bedford Street, conveniently located right off of I-95.
The Department of Orthopaedic Surgery extends its boundaries
to the north and south shores of Boston at the Lahey Clinic in
Peabody and the South Shore Hospital in Weymouth, respectively.
While these orthopaedic clinics may be smaller than those
at Children’s main campus in Boston, you can be sure that the
same care is offered in an office that might be a more convenient
outpatient alternative.
Consider making your next appointment with us at one of
our satellite locations, the Department of Orthopaedic Surgery
might just be closer than you think. View maps and directions at
www.childrenshospital.org/ortho.
Spencer Merrill (image courtesy of the Merrill family)

KID’S CORNER
t i b i a r a c b k l j
Word Bank
bones mandible
femur muscle
fibula patella
humerus ribs
leg scapula
skull spine
tibia ulna
vertebrae
Ortho News
617-355-6021
Opt. 2: Speak with a nurse
Opt. 3: Schedule/ cancel/ confirm appts.
Opt. 4: Speak with a surgical scheduler
At the 2009 Annual Meeting of the
American Orthopaedic Society for Sports
Medicine (AOSSM), Mininder S. Kocher,
MD, MPH, director of the Division of Sports
Medicine, was elected to the Board of Directors
of the AOSSM. The AOSSM is the
preeminent orthopaedic sports medicine
organization in the world for sports medicine
education, research, communication,
and fellowship.
In June, John Emans, MD, director of
the Division of Spinal Surgery, was recognized
by the National Scoliosis Foundation
for the help and hope he has given to so
many children and families in the scoliosis
community.
Michael Millis, MD, director of the
Adolescent and Young Adult Hip Program,
won the Dr. Marian Ropes Award from the
o s o x t s b i r h d h
p m n b n e f i b u l a
a q e e r t y u i m o p
t s s c a p u l a e a e
e d f k g h j e k r l a
l n m b u v c g x u z r
l w r l m l t y h s s b
a e n n s i l n u h m e
f a m u p k o d m k a t
m a n d i b l e i d a r
s c a p n t m u s c l e
w r u m e f o n o e r v
Children’s Orthopaedic
Surgery Foundation
300 Longwood Avenue/ Fegan 2
Boston , MA 02115
Arthritis Foundation. The award is for excellence
in arthritis care and leadership in
the fight against arthritis.
At the 2009 Annual Meeting of the
Pediatric Orthopaedic Society of North
America (POSNA), Peter M. Waters, MD,
Chief of Clinical Orthopaedics, was elected
Vice-President of POSNA. Following a oneyear
term, Dr. Waters will move into the
post of President-elect and subsequently
President of POSNA.
Two new videos were recently added
to our website: A Day in the Life of Orthopaedic
Surgery, featuring orthopaedic staff,
and Brachial Plexus Birth Palsy, featuring Dr.
Peter Waters. We will be expanding our
multimedia collection with future topics
that include hip dysplasia, featuring Dr.
Michael Millis, clubfoot, osteogenesis im-
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childrenshospital.org/ortho
perfecta, and leg length discrepancy. You
can view these videos and more at www.
childrenshospital.org/ortho.
Children’s recently launched a new pediatric
health and science blog, called Thrive
(www.childrenshospitalblog.org). It will feature
Children’s experts addressing timely
health topics; videos of our patients, families,
clinicians and researchers; and the latest
health information from around the world.
In addition, you can also now:
Friend us on Facebook.
www.facebook.com/childrenshospitaboston
Follow us on Twitter.
www.twitter.com/childrensboston
Watch our videos on YouTube.
www.youtube.com/childrenshospital