Seguro de Salud

Nicklaus Children’s Hospital es un proveedor de cuidados pediátricos preferido para la mayoría de los planes de seguro de salud importantes del sur de la Florida. Para los padres de familia, esto significa que su programa de seguro de salud muy posiblemente cubra el cuidado pediátrico especializados proporcionados por Nicklaus Children’s Hospital, el único hospital pediátrico en el sur de la Florida dedicado exclusivamente a los niños.

Estamos comprometidos a brindar a nuestros pacientes pediátricos el más alto nivel de cuidado en cooperación con el más avanzado servicio de manejo del cuidado médico. Nuestro Departamento de Manejo de Cuidados trabaja en estrecha colaboración con HMO (Organizaciones para el Mantenimiento de la Salud), PPO (Organizaciones de Proveedores Preferidos) y otros planes médicos para el seguimiento del cuidado de los pacientes y el monitoreo de los resultados.

A continuación se describen los planes médicos más comunes en los que participa Nicklaus Children’s Hospital junto con los respectivos requisitos de autorización del seguro para los estudios de diagnóstico más frecuentes. Los requisitos de autorización varían según cada plan/grupo y la siguiente información debe utilizarse a modo de guía. Por favor, comuníquese con su plan médico directamente para verificar si su plan de seguro participa con Nicklaus Children’s y cuáles son los requisitos de autorización ya que algunos planes de seguro utilizan redes limitadas que pueden no incluir nuestro centro.

Contáctenos

Puede comunicarse con la Unidad de Autorización al  786-624-3022 y al Departamento de Manejo de Cuidados al  305-669-5834 si necesita más detalles.


Por favor, tenga en cuenta que es posible que algunos médicos que no son empleados y miembros del personal médico con credenciales de Nicklaus Children’s Hospital no acepten todos los planes médicos mencionados en esta lista. Además, la participación en estos planes no garantiza el pago o la cobertura.

 

Authorization Policies for Aetna Better Health, Inc

Health Provider Website: https://www.aetnabetterhealth.com/
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: YES
Polysonograms: YES**
Ultrasounds: YES
Physical Therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: YES
Speech Evaluation: YES**
Feeding and Swallowing Evaluation: YES**

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-693-3211 to obtain authorization.
**Aetna members must utilize the United Health Systems Sleeps Centers. Authorizations are only valid for NCH once an attempt was made at United Health Systems.
***Aetna Better Health does require pre-cert for rehab through HN1 (DADE & MONROE) or South Florida Musculoskeletal (BROWARD & PALM BEACH). Unfortunately, at this time NCH does not have a contract with neither provider for these regions.Please verify with your health plan for an in network provider.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Aetna U.S. Healthcare, Inc

Health Provider Website: https://www.aetna.com/
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-693-3211 to obtain authorization.
** Authorizations for Polysomnograms are issued by Evicore. Please contact 1-888-693-3211 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@nicklaushealth.org or by calling 305-662-8281.

Authorization Policies for AvMed Health Plan

Health Provider Website: https://www.avmed.org/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-663-8387 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Best Doctors, Inc.

Health Provider Website: http://www.bestdoctors.com/
Accepted Health Plans: International

Does the diagnostic service require prior authorization?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@nicklaushealth.org or by calling 305-662-8281.

Authorization Policies for Blue Cross and Blue Shield
Blue options

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: PPO Federal Exchange

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-326-6302 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-855-243-3326 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
Federal plan

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: PPO

Does the diagnostic service require prior authorization?

MRI: NO
CT Scans: NO
PET: NO
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
Network Blue

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: PPO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-326-6302 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-855-243-3326 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross and Blue Shield
of Florida Health Options, Inc.

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: HMO

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-866-326-6302 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Blue Cross Blue Shield
Out of State

Health Provider Website: https://www.floridablue.com/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: CALL*
CT Scans: CALL*
PET: CALL*
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL

*Authorizations for high-end imaging (MRI, CT, PET Scans) are usually handled by a third party. Please contact the health plan directly for specifics regarding authorization submission.
Out of state policies differ in authorization requirements dependent on the state. For all authorization requirements done in an outpatient hospital setting, please contact the health plan for details.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Children Medical Services- Wellcare

Health Provider Website: https://www.wellcare.com/Florida/Members/Medicaid-Plans/CMS
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-333-2641 to obtain authorization.
**Authorizations for polysonograms are issued by Evicore. Please contact 1-888-333-8641 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Cigna Healthcare

Health Provider Website: http://www.cigna.com/
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-693-3297 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-877-877-9899 to obtain authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@nicklaushealth.org or by calling 305-662-8281.

Authorization Policies for Community Care Plan

Health Provider Website: https://ccpcares.org/
Accepted Health Plans: HMO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Coventry HMO & PPO

Health Provider Website: http://coventryhealthcare.com/
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO**
Polysonograms: YES
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: YES
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Association (NIA). Please contact 1-800-642-7821 to obtain authorization.
**Authorization requirements are based on procedure code. Please contact the Authorization Unit for verification on whether or not your specific x-ray requires authorization


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@nicklaushealth.org or by calling 305-662-8281.

Authorization Policies for First Health

Health Provider Website: https://providerlocator.firsthealth.com/
Accepted Health Plans: PPO

Does the diagnostic service require prior authorization?

MRI: CALL*
CT Scans: CALL*
PET: CALL*
X-rays: CALL*
Polysonograms: CALL*
Ultrasounds: CALL*
Physical Therapy: CALL*
Occupational Therapy: CALL*
Audio Evaluation: CALL*
Speech Evaluation: CALL*
Feeding and Swallowing Evaluation: CALL*

*Most PPO plans don't need a referral for you to see a specialist. However, check with your employer or health plan administrator to find out what your plan requires. If you need more services for diagnosis and treatment, ask your docor to refer you to another network provider.

Authorization Policies for Humana HMO

Health Provider Website: https://www.humana.com/
Accepted Health Plans: HMO PPO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Health Help. Please contact 1-866-825-1550 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Humana Medicaid

Health Provider Website: https://www.humana.com/
Accepted Health Plans: HMO PPO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: YES
Speech Evaluation: YES**
Feeding and Swallowing Evaluation: YES**


**Please note Humana Medicaid does require pre-certification for rehabilitate evaluations through HN1 for patients under the age of 21. Unfortunately, at this time Nicklaus Children's Hospital does not have a contract with HN1. Please verify with your health plan for an in network provider.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Humana PPO

Health Provider Website: https://www.humana.com/
Accepted Health Plans: HMO PPO Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Health Help. Please contact 1-866-825-1550 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Medicaid of Florida

Health Provider Website: http://www.myflfamilies.com/service-programs/access-florida-food-medical-assistance-cash/medicaid
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO*
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Only pelvic ultrasounds require authorization. Please submit authorization through the eQSuite portal. http://fl.eqhs.org/


Lab Information

Preferred Independent Lab: LabCorp, Quest or Physician Prescription
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form or prescription (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Miami Children's Health Plan LLC

Health Provider Website: https://www.miamichildrenshealthplan.com/
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Molina Healthcare of Florida, Inc.

Health Provider Website: http://www.molinahealthcare.com/en-us/Pages/home.aspx?CookieCheck=true
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: YES*
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Patients 5 years old or younger do not require authorization.


Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Multiplan

Health Provider Website: https://www.multiplan.com
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL



Authorization Policies for Preferred Medical Plan

Health Provider Website: http://www.pmphmo.com/
Accepted Health Plans: HMO

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: No Benefits
Occupational Therapy: No Benefits
Audio Evaluation: YES
Speech Evaluation: No Benefits
Feeding and Swallowing Evaluation: No Benefits



Authorization Policies for Prestige Health Choice, LLC

Health Provider Website: https://www.prestigehealthchoice.com/
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Simply Healthcare Plans, Inc.

Health Provider Website: http://www.simplyhealthcareplans.com/
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES
Ultrasounds: NO
Physical Therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: NO
Speech Evaluation: YES**
Feeding and Swallowing Evaluation: YES

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by American Imagining Management (AIM). Please contact 1-800-714-0040 to obtain authorization.
**Please note Simply does require pre-certification for rehabilitate evaluations through HN1 for patients under the age of 21. Unfortunately, at this time Nicklaus Children's Hospital does not have a contract with HN1. Please verify with your health plan for an in network provider.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Staywell-Wellcare Healthy Kids

Health Provider Website: https://www.wellcare.com/Florida
Accepted Health Plans: Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-333-2641 to obtain authorization.
**Authorizations for polysonograms are issued by Evicore. Please contact 1-888-333-8641 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Staywell-Wellcare Medicaid

Health Provider Website: https://www.wellcare.com/Florida
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-888-333-2641 to obtain authorization.
**Authorizations for polysonograms are issued by Evicore. Please contact 1-888-333-8641 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Sunshine State Health Plan

Health Provider Website: https://www.sunshinehealth.com/
Accepted Health Plans: Medicaid Healthy Kids

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by NIA Please contact 1-866-214-2569 to obtain authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Tricare

Health Provider Website: https://www.mytricare.com/mtc/
Accepted Health Plans:

Does the diagnostic service require prior authorization?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL




Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for UMR

Health Provider Website: https://www.umr.com/tpa-ap-web/
Accepted Health Plans: HMO PPO

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: NO
Polysonograms: CALL
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO




Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for United HMO-PPO

Health Provider Website: https://www.myuhc.com/member/prewelcome.do
Accepted Health Plans: HMO PPO International

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: YES**
Ultrasounds: NO
Physical Therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding and Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by United Healthcare. Please contact 1-866-889-8054 to obtain authorization.
**Patients 5 years old or younger do not require authorization.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@nicklaushealth.org or by calling 305-662-8281.

Authorization Policies for United Medicaid

Health Provider Website: https://www.myuhc.com/member/prewelcome.do
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: NO
Polysonograms: NO
Ultrasounds: NO
Physical Therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: NO
Speech Evaluation: YES**
Feeding and Swallowing Evaluation: YES**

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by United Healthcare. Please contact 1-866-889-8054 to obtain authorization.
**Authorizations are only given for an outpatient hospital setting for certain high acute diagnoses. Please contact UHC Medicaid for more information.


Lab Information

Preferred Independent Lab: LabCorp or Quest Diagnostics
Laboratory testing cannot be administered without the required forms. Please bring the LabCorp form or Quest Diagnostics form (provided by your doctor) to your appointment. Lab Hours of Operation are from 7 a.m. to 3 p.m. Monday through Friday and 7 a.m to 11 a.m. on Saturdays. Labs are closed Sundays. For additional information please call 305-666-6511 ext 1964.

Authorization Policies for Virgin Islands Medicaid Program

Health Provider Website: http://www.dhs.gov.vi/financial_programs/medical_assistance.html
Accepted Health Plans: Medicaid International

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

For more information, please contact the Global Health Department via e-mal at globalhealth@nicklaushealth.org or by calling 305-662-8281.