If your child is referred for a medical service the referring doctor will send a request for authorization to Children’s Physicians Medical Group (CPMG). The request is reviewed by CPMG clinical staff.
You and your doctor will be notified by mail of any decision, whether authorized or denied. If a denial of coverage is issued, you have the right to appeal that decision with your health plan. You will receive a letter with information on how to appeal the denial.
Any policies or clinical criteria used to make an authorization decision are available upon request from CPMG. If you have any questions about this process or your authorization request, please contact us.