Getting Insurance to Cover a Developmental Pediatrician

Updated on November 02, 2011
T.N. asks from Los Angeles, CA
5 answers

Hi Moms.
This question is related to my previous question. Please see my previous question for more detailed information. This site has proven very helpful for me. My son is covered under a PPO insurance that is known to be a relatively good insurance plan. However, when I went to their website to find a developmental pediatrician, there were only 2 within 60 miles, this being in Los Angeles, a major metro area. I am willing to pay for services, but I can't go broke. How have some of you moms being able to see a developmental pediatrician? The only case I know of is a relative who paid $3000 to have her son diagnosed and that did not include any therapy. Ugh, so confusing.
Thanks.

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So What Happened?

Thanks for all the info. All of the answers have been really helpful. Previously, I had kind of given up on the developmental pediatrician, because a local children’s hospital has a clinic where they have an interdisciplinary team that sounded great and they will help with insurance coverage, however, you are ultimately on the hook financial as you sign a financial contract stating that you are responsible for all charges if insurance does not cover. These charges are up to $5000. And thanks for the recommendation on the neurologist/psychiatrist, insurance has plenty that are in network that specialize in pediatrics. I want to avoid out of network if can, because that’s a gamble, there is not a contracted rate and the provider can really charge what they want and the insurance just pays to a percentage reasonable and customary charges.
Update 2: I was able to get a developmental pediatrician through UCLA that is covered in network as a specialist. I am very happy. And my appointment is slightly less than a month away. The reason at first that I thought I only had 2 pediatricians that were developmental is because the way the insurer’s database categorizes developmental pediatricians, some were just not listed as that, they were just plain pediatricians. My original intent was to start with a developmental pediatrician, but someone on one of my other questions had suggested a neurologist or psychiatrist. Thanks for info about the regional center all of the information that the moms have posted has been extremely helpful in trying to figure things out.

More Answers

J.W.

answers from St. Louis on

You have the same options as everyone else. You either go to the in network providers or you pay the out of network price. Your son's circumstances have no bearing on the outcome.

Without taking the time to find your other post I have to wonder if you are not being too specific in your needs. My kids have all sorts of issues the worst being Autism spectrum. No one has ever recommended a developmental pediatrician.

Okay that other post wasn't helpful and really long.

Start with a neurologist to rule out issues of the structure of the brain and then most on to a psychiatrist to go with mental. You will find there are a lot more of them that are covered than some obscure title as a developmental pediatrician.

2 moms found this helpful

M.B.

answers from Orlando on

If you can find one close to you that's not covered and file a claim to have them covered because there's none around you. That's what I had to do with my son and a child pyschiatrist. The dr you want to see could help with the process, and if it's a needed survive the insurance should cover a non provider. Good luck

2 moms found this helpful
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P.A.

answers from Los Angeles on

Did you try Dr. Anshu Batra Appointment Info
Address & Contact Information:
Batra and Griesbach Mds
11835 West Olympic Boulevard Suite 1200E
Los Angeles, CA 90064
Is there a reason you feel you need a neurologist/psychiatrist as apposed to a developmental ped?? These are two totally different fields. Let us know what happens. Also if you get a diagnosis your therapy may be covered by the regional centers.
If you need further help pls feel free to contact me at the email address below.

Penny Amic CEO/Clinical Director
Special Beginnings, Inc.
An Early Intervention Network
____@____.com
###-###-####

1 mom found this helpful
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S.B.

answers from Redding on

I haven't read your other post, but if your current pediatrician gives you a referral to a developmental pediatrician and there aren't any in your insurance carrier's network in your area, you can request an "out-of-network" referral. If granted, that means that the insurance would pay another medical provider closer to you at the same rate they would pay a regular network provider. However, in doing that, you have to understand that you would have to pay any fees above and beyond what the insurance would pay because that particular doctor is not contracted with your insurance carrier. It could help cover some of the fees.

I would contact your insurance carrier directly to ask them about how an out-of-network referral works.

Good luck.

1 mom found this helpful
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R.Y.

answers from New York on

Start with the people listed on the insurance. Try talking to someone at your insurance company. Sometimes you can get to talk to someone who knows how the system works best. Also are there evaluation programs at any nearby hospitals, particularly a childrens's hospital or a university hospital? The department in the hospital may have a person who can help you deal with the insurance issues. Good luck.

1 mom found this helpful
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