The more often policyholders visit the doctor and receive specialist referrals, the higher their annual insurance costs. This goes for children and adults on private and public, state-sponsored insurance programs. Like other individuals, children also face challenging health conditions, health insurance restrictions and increased child health insurance premiums. Children with pre-existing conditions and kids that require special medical care available exclusively through a specialist generally have higher premiums. Insurance companies charge higher rates to policyholders that use more services than their healthy counterparts. Co-pays for health care services and doctor appointments, annual premiums and deductibles affect the cost of specialist referrals under child health insurance plans.

All child health insurance plans vary in their coverage options, exclusions and premiums. However, the two most common forms of child health insurance handle specialist referrals differently. Policyholders that receive standard primary care benefits might need a referral to see a specialist such as a dermatologist, allergist, surgeon or advanced physician. In this case, it's imperative to have an official referral issued by the Primary Care Physician. These referral-based plans are generally the most affordable child health insurance plan in terms of annual premiums. Other premium plans allow policyholders to visit any specialist they choose without a referral. These no-referral child health insurance plans are typically more expensive, but they offer more freedom and flexibility with fewer restrictions.

Parents and primary policyholders that insure their children using a referral-based program must complete the official referral process to receive specialty care, non-emergency hospital care and other advanced medical services. In emergency situations, most child health insurance plans don't require specialist referrals. However, failure to secure an authorized referral often results in claim denials for services that were not formally recommended by a primary care physician. Seeing a specialist for a chronic health condition, food allergies or emergency events may result in pro-rate increases compared to someone who doesn't use these services. In most cases, specialist referrals have higher co-payment rates or lower co-insurance rates than services provided by general physicians.

In some cases, higher annual premiums for child health insurance result in lower out-of-pocket expenses and better coverage. Parents that take their children to specialists for routine medical care often benefit from premium, referral-free child health insurance plans. By paying a little more annually and eliminating the need for referrals, parents can take children with special health concerns to an appropriate specialist without waiting for a referral or filing a claim. Adjusting benefits, policy limits, deductibles and coverage options effectively alters annual premiums. Parents that anticipate frequent visits to specialists or major medical expenses might save more in out-of-pocket expenses by paying higher premiums and selecting a superior child health insurance plan.