What Expenses Does Insurance Usually Not Cover for Sick Children?

The B.A.B.Y. Foundation
14 hours ago
3 min read

What families wish they had known sooner.

No one sits down with a newborn—or a newly diagnosed child—and a spreadsheet.

When your child is sick, your focus is singular: getting them better.

Insurance is supposed to help. And often, it does. But many families discover—too late—that insurance doesn’t cover nearly as much as they assumed. The result isn’t just confusion. It’s shock. Stress. And a growing pile of bills no one warned you about.

This post exists to offer clarity—so families can plan, breathe, and know they’re not imagining things when the costs feel endless.

The Hard Truth: Insurance Rarely Covers the Full Picture

Most insurance plans are designed to cover medical treatment, not the reality of caregiving.

That gap—the space between treatment and real life—is where families feel blindsided.

Below are some of the most common expenses families face when a child is sick that insurance often does not fully cover (or doesn’t cover at all).

Deductibles, Co-Pays, and Out-of-Pocket Maximums

This is the most obvious—and still the most overwhelming.

Even with “good” insurance, families are responsible for:

High deductibles before coverage begins
Co-pays for hospital stays, specialists, and follow-ups
Out-of-pocket maximums that reset annually

For long hospitalizations or ongoing conditions, these costs add up fast—sometimes in days or weeks. .

Therapies Not Fully Covered (or Limited)

After discharge, many children require:

Physical therapy
Occupational therapy
Speech therapy
Developmental or early intervention services

Insurance may limit:

The number of visits per year
Coverage by provider or diagnosis
Approval for long-term therapy

Families are left choosing between their child’s progress and their budget.

Medical Equipment for Home Care

Insurance often does not fully cover:

Specialized feeding equipment
Monitors or adaptive devices
Mobility aids
Replacement supplies

Even when equipment is approved, families may still owe significant portions—or wait weeks for approval while their child needs support immediately.

Medications and Specialized Treatments

Insurance may deny or partially cover:

Off-label medications
New or specialized treatments
High-cost prescriptions

Families are often forced into appeals or out-of-pocket payments just to access what doctors recommend.

Why Families Feel Blindsided

Most parents don’t learn about these gaps upfront.

They find out when:

Bills arrive weeks later
Coverage is denied unexpectedly
Savings are already stretched
They’re too exhausted to fight another system

And with that comes guilt—Should we have planned better?—even though no one plans for their child to get sick.

This Is Where Community Support Matters

Families shouldn’t have to navigate medical crises and financial uncertainty alone.

When insurance stops short, local support can step in to help cover medical-related expenses and relieve some of the pressure—so parents can focus on care, not costs.

That’s why organizations like The B.A.B.Y. Foundation exist: to help bridge the gap between what insurance covers and what families truly need during a child’s medical crisis—right here in Northern Colorado.