The AAP encourages chapter development of pediatric councils as forums to discuss pediatric issues with payers. Pediatric councils have the potential to facilitate better working relationships between pediatricians and health insurance plans and to improve quality of care for children. Ideally, changes may lead to more appropriate coverage for pediatric services, as well as smoothly and efficiently run pediatric practices and health plan claims adjudication. A pediatric council is not a forum for joint contract negotiation, individual contract discussion or other fee-related concerns.
Below are several resources to assist chapters in developing and maintaining pediatric councils.
Private Payer Advocacy Contacts
Chapter Pediatric Councils meet regularly with health plans to discuss access, quality and coverage issues impacted by health plan coverage and administration policies.
Pediatric Council Guidebook
Pediatric councils serve as a forum for pediatricians to discuss with payers concerns about covered services, plan policies and administrative procedures, which impact access, quality, efficiency of treatment and payment. Chapters have reported that these councils facilitate communication and lay the groundwork for successful problem solving with individual payers.
Pediatric Council Shared Resources
Links to PowerPoint presentations, talking points and forms developed by AAP Chapter pediatric councils that can be tailored by other pediatric councils for their own discussions with payers.