July 11, 2019 – I was back at Copley for this visit with the Medical Practice Foundation’s Central Authorizations Unit. This is the team that secures funding (insurance authorizations) for kids who need outpatient services in dozens of Rady Children’s specialties.
For this journey, my trail guide, Angela Graul, hooked me up with a Rady Children’s backpack filled with goodies and a map that would guide me through the various pods that comprise the CAU. We stopped at an outpost (complete with trail mix, fruit and water) that provided some background on the unit. One statistic that jumped out at me is that, last year, the CAU was responsible for ensuring funding for 868,354 patients. That’s 72,363 appointments and referrals per month!
The following eight pods make up the unit, each divided into the specialties they support:
- Pod 1 supports allergy, asthma/immunology, cystic fibrosis, gastroenterology, otolaryngology and pulmonology. U.S. News and World Report ranks two of these specialties (pulmonology and gastroenterology) among the top programs of their kind in the country.
- Pod 2 secures authorizations for dermatology, endocrinology (including diabetes), the failure to thrive clinic, high-risk infant follow-up, nephrology, pediatric surgery and Rett syndrome. This team also works with patients from another U.S. News top-ranked specialty: nephrology.
- Pod 3 is proud to support orthopedics, rehabilitation medicine and spinal defects. This pod stands out because it secures authorizations for orthopedics, a division consistently ranked among the top 10 in the country.
- Pod 4 supports cardiology (including echocardiogram and EKG) and perinatology. Cardiology is another specialty that is ranked among the nation’s best year after year.
- Pod 5 takes great pride in securing authorizations for ophthalmology. They work hard to ensure continuity of care with the Shiley Eye Institute at UC San Diego.
- Pod 6 supports the most specialties, securing authorizations for craniofacial, Down syndrome, genetics/dysmorphology, gynecology, metabolic, muscle disease, neurology, neurosurgery, plastic surgery, rheumatology and urology. This team also represents patients seeing physicians in the top-ranked neurology and neurosurgery specialties.
- Pod 7 provides support for services that overlap specialties such as referral entry; customer service/provider line; authorizations for MRI, CT and other scans; and specific occupational and physical therapy authorizations.
- Pod 8 supports behavioral health, chronic pain, infectious diseases, nutrition and supportive care. A couple of interesting things about this pod: The chronic pain team secures authorizations for the new chronic pain clinic, which was launched just a few months ago. The supportive authorizations team works to assist patients who cannot physically travel to appointments, making sure the care comes to them.
Once I reached the summit of this journey, I headed to a conference room where I got to meet members of the CAU in person. They had some great questions for me and even presented me with my own framed referral!
This group exemplifies why it takes every Rady Children’s employee to look after the children in our care. They tirelessly advocate for our patients and families, working to ensure they receive the services they need. Part of my vision for Rady Children’s is to be recognized as one of the nation’s elite children’s hospitals, and, with this team in place, I know we can get there!