; Skip to Main Content
Skip Nav Destination

Subspecialists benefit from AAP private payer advocacy :

February 1, 2017

One aspect of AAP private payer advocacy is to review insurance carrier policies to ensure they cover recommended pediatric services and provide payment to primary care and subspecialty pediatricians. Such review is not an endorsement of a carrier’s policy but an opportunity to advise the carrier on the policy’s impact on pediatrics and pediatricians.

The policy is shared with the appropriate AAP council, committee or section for review, and feedback then is forwarded to the carrier. When a carrier's policy is not in alignment with AAP recommendations, the reviewing group recommends a response from the Academy.

The Academy has facilitated review of the nation’s largest private carriers’ clinical policies to incorporate pediatric perspective. Recent successes on subspecialty pediatric issues include the following:

  • The AAP Committee on Fetus and Newborn and Section on Neonatal-Perinatal Medicine developed comments on the UnitedHealthcare (UHC) policy on inhaled nitric oxide (INO) and had a follow-up conference call with its authors. As a result of that discussion, UHC revised its policy regarding non-coverage for INO in neonates born at less than 34 weeks.
  • Based on input from the AAP Section on Cardiology and Cardiac Surgery, Anthem revised its policy on implantable cardioverter defibrillators to expand the pediatric indications for implantation to include all adult indications considered medically necessary when criteria are met.
  • Members of the AAP Section on Otolaryngology–Head and Neck Surgery provided clarification and peer-reviewed published reports supporting digital sound processing for certain types of hearing loss and urged Anthem and the Blue Cross Blue Shield Association to provide appropriate benefits coverage. In light of the information provided, clarifications on medical necessity for bone conducted hearing loss were included in policy templates.
  • The AAP Section on Urology worked with the AAP Private Payer Advocacy Advisory Committee (PPAAC) to develop appeal letter templates for its members to advocate for benefits coverage for biofeedback therapy for lower urinary tract dysfunction, testicular prostheses and treatment with Deflux for children with vesicoureteral reflux. The templates are available at http://www2.aap.org/sections/urology/.

Dr. Lander is chair of the AAP Private Payer Advocacy Advisory Committee.

Close Modal

or Create an Account

Close Modal
Close Modal