Step 1: Request an Appointment for your Child
- Handling your appointment request by phone is a great way to obtain answers from helpful staff regarding which clinic or physician is best for your child’s health care needs. Please note that, for many insurance companies, a pre-authorization is needed in order for your child to be seen by a subspecialist. This often requires information from your child's primary care physician or pediatrician along with the authorization. For additional information, please refer to Step 2 below.
- If you are scheduling a follow-up appointment, you may do so as part of your check-out process at our hospital’s clinics.
Step 2: Referrals and Authorization for Care
Many insurance plans require families to obtain “referrals” and “pre-authorizations.” If your family's plan requires this, you will need to make sure that authorizations or referrals are taken care of before you receive services at Children’s Hospital Los Angeles.
- You may be able to schedule services before receiving notice of authorization. The service may be canceled or rescheduled if authorization is not approved by your insurance company. If your insurance company needs a referral and/or prior authorization, call your primary care doctor before scheduling an appointment with us.
- This process will be different depending on the type of health insurance coverage your family has.
Types of Health Insurance
Commercial PPO Insurance Coverage
If your family is insured through a Commercial Preferred Provider Organization (PPO), you do not need an authorization from your child’s doctor, but we will need a referral packet provided to enable the triage process and determine the medical urgency and appropriate physician for your child. Our staff can assist you if you need assistance selecting a care provider — please contact us at 888-631-2452 for assistance.
- Should your child require diagnostic services such as lab or x-ray while being seen by our specialists, pre-authorization is typically required by PPO plans. It will also mean that the amount of your family’s coverage for these services will be determined by your family’s PPO coverage.
Commercial HMO Insurance Coverage
If you have insurance provided through a Health Maintenance Organization (HMO), our staff will work with you to ensure that you have received a referral from your primary care physician after an appointment is requested (Step 1 above). Once the referral has been obtained (you or your Primary Care Physician can call, fax or email the referral documentation to us) we can initiate the insurance process.
Medi-Cal (Straight Medi-Cal)
If you are enrolled in California’s Medi-Cal program or another state’s Medicaid program, a Treatment Authorization Request (TAR) is required. This process is governed by state and federal law and Children’s Hospital Los Angeles is required to request authorization before providing non-emergency medical services to your child. Your pediatrician will know how to submit a TAR for Children’s Hospital Los Angeles. Out-of-state patients covered by Medicaid should consult their state program guidelines.
(CCS) California Children’s Services
If you are enrolled in the California Children’s Services (CCS) insurance coverage program, a Service Authorization Request (SAR) is required. This process is governed by state and federal law and Children’s Hospital Los Angeles is required to request authorization before providing non-emergency medical services to your child.
Step 3: What to Bring with You
Due to the complex nature of pediatric specialty care, our experts often request that parents or referring pediatricians provide additional detailed health information prior to first-time visits. Our staff will confirm the items you will need to bring to your visit with you when you schedule your appointment. Examples of things you may be asked to bring include:
- Medical records from visits with other doctors or medical experts
- X-ray films
- Lab results
- Medication list (including medication strengths, amounts taken, and over-the-counter medication) or bring the original prescription bottles with you
- Information about your child’s allergies