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Pediatric Specialists: Coverage Information

Work with your pediatrician to choose a pediatric specialist and or pediatric surgical specialist in your plan.

Prior Approval and Coverage

Under most health plans, if you see a pediatric specialist and or pediatric surgical specialist without the approval from your pediatrician, you will have to pay for these services yourself.

If you decide to use a pediatric specialist and or pediatric surgical specialist who is not in your plan, check your contract for details about whether you or your plan will pay for the care and how much it will cost.

Medically Necessary?

Usually, a managed care plan relies on the primary care doctor to determine if a service is medically necessary. However, the plan may limit the pediatrician's options by having a specific list of treatments that are approved for certain illnesses.

Additional Resources

Last Updated
American Academy of Pediatrics (Copyright © 2013)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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