We currently participate in many insurance and managed care programs. Their rules change frequently and often without our knowledge. Although it is ultimately your responsibility to be aware of the requirements of your individual plan, we will assist you in any way possible. We have prepared the following guidelines:
- You need to know where non-emergency x-ray, laboratory and subspecialty services are covered under your individual plan. We can offer suggestions but please verify with your plan that our suggestions are in-network. If you are out of state (on vacation) please read your insurance card first as most plans have a phone number to contact for out-of-network assistance.
- For Specialist Appointments:
Obtain the approval of your pediatrician.
Verify that the chosen specialist is approved under your plan.
Schedule the appointment with the specialist.
We request at least three business days prior to the appointment, but no earlier than three months for notification. Urgent appointments can be accommodated.
The majority of insurance companies will not allow us to “back date” referrals and a prescription from the doctor is not a referral for all plans. You may require an electronic referral or authorization number. Please call your insurance company if you are unsure what is required.
Pre-Authorization and pre-x authorizations may take from 3 to 7 days to process, often requiring notes from the doctor or specialist.
Please contact our Insurance/Referral Coordinator with your referral request and include the following information:
Child’s name and date of birth
Name of doctor referring child to specialist
Name of insurance company
Name of specialist / facility and appointment date
Reason for referral
Contact name and daytime phone number
Remember, submission of the referral or authorization is not a guarantee of payment. Managed care plans may deny payment even if everything is completed correctly. This then becomes your financial responsibility.
- Emergency Room Visits:
Please call the Insurance/Referral Coordinator within 24 hours if a referral is required by your insurance company.
We have a doctor on call 24 hours a day/ 7 days a week. Please call our office and speak to our nurse, secretary, or have our answering service page the doctor on call if you unsure whether to make an appointment or go to the emergency room.
Please check your insurance card for instructions on what they require in an emergency situation.
- Mental Health Referrals:
These usually do not involve the pediatrician. Information can usually be found on your insurance card. Please notify us as soon as possible if special circumstances arise and we will do our best to assist you.
Additional Helpful Resources:
- Kids Health – www.kidshealth.org
- Healthy Children – www.healthychildren.org
- Children and Adults with Attention Deficit/Hyperactivity Disorder – www.chadd.org
- Food Allergy and Anaphylaxis Network – www.foodallergy.org
- Nursing Mothers, Inc. – www.nursingmoms.org
- American Academy of Child & Adolescent Psychiatry – www.aacap.org
- American Academy of Pediatrics – www.aap.org
- Center for Disease Control – www.cdc.gov
- American Academy of Pediatrics
- Centers for Disease Control
At Just Kids Pediatrics we and our friendly staff offer all aspects of pediatric medical services:
- Well child exams
- Sports and camp physicals
- Pre-op physicals
- School and behavioral issues
- Acute and chronic illnesses
- Nutritional consultations
- Developmental screenings
What is a Pediatrician?
A pediatrician is a physician whose specific specialty is caring for children from birth to the age of adulthood. Pediatricians address acute and chronic illnesses, learning disabilities, behavioral issues and the growth and development of children. Our goal is to help ensure that children grow into mentally and physical healthy, productive and happy adults.