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​In addition to hospital admission and emergency room services, high-risk or high-cost services usually need prior approval. These may include:

How to Get Prior Approval

You must get prior approval from your pediatrician or your plan, whether for pediatric specialty care, pediatric surgical specialty care, or hospital services.

When A Second Opinion is Required

Some plans require a second opinion from another doctor before approving certain types of care. Your plan is likely to require this second opinion from another doctor in your plan. This doctor may or may not be a pediatrician or pediatric specialist and or pediatric surgical specialist.

 

Last Updated
10/3/2013
Source
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.