Work with your pediatrician to choose a hospital in your plan that specializes in the care of children.
- If your plan does not include one, talk to your pediatrician about what arrangements will be made if and when your child requires care at a hospital that does specialize in children.
- If you go to a hospital that is not in your plan without prior approval, you may have to pay for part or all of the cost of those services.
Hospital Services Requiring Prior Approval
Most hospital procedures and surgeries, both outpatient and inpatient, require prior approval.
Your plan may require that certain procedures and surgeries be done on an outpatient basis in order to be paid for by the plan.
For inpatient hospital care, managed care plans often limit the number of days they will pay for your child to stay in the hospital. Coverage for longer stays requires approval by the managed care plan. Without such approval, you may be responsible for part or all of the hospital and physician charges.