We recommend all patients contact their insurance company prior to visiting our office. Failing to check with your insurance company and following their requirements may result in you being responsible for non-covered expenses incurred from your visit.

Insurance Information

What to Ask

  • Is a referral required for my child’s visit? If the answer is yes, you will have to contact your primary care physician to obtain one and have it sent to our office prior to your visit with us. Our office can not obtain referrals for you.
  • Is the surgeon and CHKD considered in-network or out-of-network for my specific plan? This normally determines the out-of -pocket percentage for which you will be responsible.
  • What portion of the bill(s) am I responsible for in regards to office visits, diagnostic testing, and surgery? Once you get this percentage from your insurance company, we can help you determine the estimated cost for your visit to our office and/or surgery and ancillary testing.

As a courtesy, our office and Children's Hospital of The King's Daughters will bill your insurance company for you. To do so, we need your cooperation in obtaining current insurance information and a copy of your insurance card.

If there is a difference between what your insurance pays and the total bill, you will be responsible for that amount. You should also notify our office immediately at (757) 668-6877 if your insurance company or plan changes. If this occurs, it is important you review the questions listed above with your new insurance company or plan.

Surgical Authorization

We will work with your insurance company to try to obtain a surgical authorization if your child is scheduled for surgery. Please note we can only obtain a surgical authorization once your child has been evaluated by our surgeon and a specific date for the surgery has been selected.

Many insurance companies only allow us to obtain an authorization 45 days in advance of the scheduled surgery date. This process can be very complex and often takes several days (or possibly weeks) to obtain the authorization. Should additional information be required by your insurance company, we will contact you.

We try to accommodate all insurance company requests in a timely manner and will try to keep you updated on the status of the surgical authorization.

Obtaining a surgical authorization is not a guarantee of payment; therefore, we strongly suggest you personally contact your insurance carrier about your plan coverage. There are times when we are unsuccessful in obtaining a surgical authorization. This is very difficult for our office and for you. At this point, we are forced to cancel the surgery but encourage the patient to contact their insurance representative to appeal the denied authorization.

Self-pay Procedures

If you plan to pay out-of-pocket, you will be classified as self-pay and are required to contact our office prior to your visit at (757) 668-6877 to discuss payment options.

Prescription Information

Many of you may have prescription benefits through a separate  plan that is not part of your health insurance. It is extremely important you verify with your plan that the following medications are covered and do not require a pre-authorization.

Name of Medicine

  • Percocet
  • Robaxin
  • Advil
  • Valium
  • Colace
  • Zofran

If any of the medications listed above require a pre-authorization through your prescription insurance plan, it is your responsibility to notify our office of this prior to your child’s surgery. We will work with your prescription insurance carrier to obtain an authorization; however, if we are unable to obtain one, we will need to change the medication to a similar one that can be authorized. This is important so we can ensure your child receives the same medications once discharged from the hospital. Medications will be prescribed to your child by the surgeon or physician extender upon discharge from the hospital. Questions regarding medications should be asked at this time.

* Please note that we do not have the authority to prescribe medications outside the state of Virginia.