Primary care pediatricians, pediatric medical subspecialists, surgical specialists and the families they serve are seeing the fruits of AAP efforts to provide a pediatric perspective on insurance carrier policies.
The Academy was one of the first specialty societies to initiate a process to facilitate pediatrician input on the coverage policies of the nation’s two largest private health plans — UnitedHealthcare (UHC) and WellPoint. The process calls for carrier policies to be forwarded to AAP private payer advocacy staff and the appropriate AAP council, committee or section.
Commentary provided during a review does not serve as AAP endorsement or repudiation of that particular policy. Instead, reviews primarily are an opportunity to evaluate whether there is any clinical variation between the health plan’s medical policies and AAP policy.
“Allowing pediatricians to provide current medical information to carriers is invaluable and can influence them to change their policies,” said Ellen Elias,...