Pediatric Council

Quality Care for Children

What is the Pediatric Council

The AAP is your advocate for both public and private payors to ensure that all infants, children, adolescents and young adults are covered by affordable, quality health insurance plan that allows access to comprehensive essential care to ensure optimal health.

Pediatricians continue to face issues with insurance carriers, managed care organizations, employers and other purchasers of health care (collectively referred to as payers).  Often these payers do not fully appreciate or realize the impact of their plans, programs, policies and processes on children’s access to quality, comprehensive care, nor the need for appropriate payment to support these services being delivered both nationally and on a regional level by you as outstanding providers of quality pediatric care.  The AAP Payer Advocacy Advisory Committee (PAAC) was formed to address appropriate benefits coverage through education and advocacy at a national level and local Pediatric Councils function at a chapter level and attempt to share PAAC key messages as they address local and more regional issues.

The following guidelines and limitations must be strictly adhered to by those participating within AAP Pediatric Councils:

  • There should be no exchange of payment information
    • which includes fees, price or cost data by individual pediatricians, pediatric medical subspecialists or other health providers.  Sharing of fee schedules and other fee or cost information by competitors in this context is strictly prohibited by antitrust laws
  • Pediatric Councils must not be used to negotiate with purchases of health care services
    • on any term or condition of payment or to otherwise attempt in any manner to put pressure on any purchases by implying or threatening a boycott of any plan that does not follow the Chapter’s recommendations
  • Each health care provider must make independent decisions
    • based on their own individual circumstances regarding what fees to charge, rates to accept and contracts to accept
  • The Pediatric Council is not intended as a substitute for legal advice
    • each AAP Chapter and the physicians who participate should consult with a qualified health care attorney about the limits placed on their conduct by the antitrust laws in the sue of the information obtained via the Pediatric Council
  • Use of pediatric councils by the AAP Chapters or individual health care providers in any manner to limit competition or restrain trade is strictly prohibited by state and federal antitrust laws and is subject to severe penalties

Payment Information & Resources

The AAP has webpages and resources to help you learn more about immunization coding and payment issues and strategies. Some include: The AAP Coding Hotline – Use this to submit your coding/payment issue.

Examples of the Pediatric Council’s Activities

If you identify a concern for the Pediatric Council please submit your request through this link.