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Having Surgery at Children's

Insurance and Referrals

Having Surgery at Children's - Insurance and Referrals 
Please Have the Following Information on Hand

  • Name and telephone number of the child’s insurance company
  • Policy holder’s name, social security number, place of employment, and work phone number
  • Policy and group numbers
  • Name, address, and phone number of your child’s referring physician

Know What Your Insurance Company Requires
Most insurance companies require you to take certain steps before they will cover the cost of a surgical procedure for your child. Every parent should contact their insurance company to ask the following questions:

  • Does the insurance company require a referral from the primary care physician?
  • Does the insurance company require a second opinion?
  • Does my insurance plan have a deductible?
  • Does my insurance plan require a co-pay?
  • Is there a pre-existing clause in my insurance plan?


Does The Insurance Company Require a Second Opinion?
If the insurance company requires a second opinion, it is the parent and/or guardian’s responsibility to obtain one. Your primary care physician can suggest doctors to call.


What if My Child Isn’t Covered by Insurance?

If you do not have health insurance, our financial counselors can help you determine if you are eligible to apply for Medical Assistance (Medicaid) and will help you through the process. We also can help you apply for our charity or financial assistance programs. Based on the first letter of your last name, the counselors can be reached at:

  • A-K: (202) 476-5616
  • L-Z: (202) 476-5505

Extended payment arrangements may be considered on an individual basis during your consultation. Please contact a customer service representative Monday through Friday, 9 am to 4 pm, at (202) 476-3500. You also can visit the Financial Information Center located in Room 1820 by the gift shop on the first floor of the West Wing of the main hospital.

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Patients and parents/guardians have the responsibility:

  • To provide, to the best of their knowledge, accurate and complete information about all matters relating to the child’s health.
  • To the extent allowed by law, to both formulate advance directives and expect hospital staff and practitioners who provide care will comply with these directives.
  • To be considerate of other patients and staff and to encourage the patient’s visitors to be considerate as well.
  • To pay for services provided, and/or provide necessary information to process insurance claims related to your child’s hospital and outpatient service bills.
  • To follow the treatment plan recommended by the practitioner and agreed upon for the patient’s care.


Informed Consent and Advance Directives

If you are an adult patient age 18 or older who has the ability to make an informed decision, you have the right to make your own medical treatment decisions. You also have the right to draft an advance directive giving instructions for health care when you are no longer able to participate in treatment decisions. For copies of advance directives call the Preoperative Care Center at (202) 476-7622, or speak with your nurse or doctor.


Having Surgery at Children's - Insurance and Referrals 
A Note to Parents of Adult Children
At age 18, children become legally responsible for providing consent for all medical treatments. However, if you or your doctor feel that your child is not able to understand the risks and benefits of medical treatment and cannot make informed medical decisions, a legal guardian must be appointed for that purpose. To obtain legal guardianship over an adult child, parents must apply to probate court in the county where the child lives. For more information, please contact a lawyer or the probate court.


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Information about Consenting Parent/Party
This information is provided to clarify who may sign paperwork and consent to evaluation and treatment for a child at Children’s National. If you have any questions about this information, please contract your provider.


IF YOU ARE AN ADULT PATIENT AGE 18 OR
OLDER WHO HAS THE ABILITY TO MAKE AN
INFORMED DECISION, YOU HAVE THE RIGHT
TO MAKE YOUR OWN MEDICAL TREATMENT
DECISIONS. 


Biological Parent:
The biological parents are the child’s natural mother and father, i.e., the woman who gave birth to the child, and the man who fathered the pregnancy. Biological parents may sign all paperwork on the child’s behalf and may consent to evaluation and treatment unless a court has determined that the parent no longer has this right. By signing any paperwork at Children’s National, the biological parent certifies that there has been no court action which would prevent them from doing so.

Adoptive Parent: The adoptive parent is the parent who has been granted adoption of the child by court order. A copy of the court’s approval of the adoption must be provided to Children’s National in order for the adoptive parent to sign paperwork or consent to evaluation and treatment for the child.

Foster Parent: The foster parent may or may not be able to sign paperwork for the child, depending on which state and county in which the child lives. If you are the child’s foster parent, please contact the child’s social worker to clarify what you are permitted
to sign for and to request documentation from the social worker indicating this. You will be required to present paperwork from the county establishing your ability to consent prior to the child being seen or treatment being given. Please also give the social worker’s name and phone number to the child’s provider so that we may contact the social worker directly if questions arise.

Caregiver Or Other Family Member: The caregiver or other family member may not sign any paperwork on the child’s behalf, nor may they consent to evaluation or treatment unless they provide written authorization to do so signed by one of the biological parents. A copy of this authorization is enclosed for your use. This authorization will expire 60 days from the date the parent signs it.

Parent Requesting Accommodation of a Divorce Decree: In an instance when the divorce decree changes either parent’s rights to consent to a child’s treatment, Children’s National needs to have a copy of that court decree. The court order may be brought the day of the surgery.

It is important that you bring any required paperwork referenced above to the child’s first appointment at Children’s National to avoid the need to cancel appointments orprocedures.



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