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


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.

 

Aetna Better Health, Inc

Políticas de autorización de Aetna Better Health, Inc

Sitio web del proveedor: https://www.aetnabetterhealth.com/
Planes de seguro aceptados: Medicaid Healthy Kids Behavioral

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) 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.

Aetna U.S. Healthcare, Inc

Políticas de autorización de Aetna U.S. Healthcare, Inc

Sitio web del proveedor: https://www.aetna.com/
Planes de seguro aceptados: HMO PPO Federal Exchange Behavioral International

¿Se requiere una autorización previa?

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 1-800-792-8744 to obtain authorization.
** Authorizations for Polysomnograms are issued by Evicore. Please contact 1-800-792-8744 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.

AmeriHealth Caritas

Políticas de autorización de AmeriHealth Caritas

Sitio web del proveedor: https://www.amerihealthcaritasfl.com/
Planes de seguro aceptados: Medicaid

¿Se requiere una autorización previa?

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.

AvMed Health Plan

Políticas de autorización de AvMed Health Plan

Sitio web del proveedor: https://www.avmed.org/
Planes de seguro aceptados: HMO PPO Behavioral

¿Se requiere una autorización previa?

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 Evicore. Please contact 1-800-792-8744 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.

Best Doctors, Inc.

Políticas de autorización de Best Doctors, Inc.

Sitio web del proveedor: http://www.bestdoctors.com/
Planes de seguro aceptados: International

¿Se requiere una autorización previa?

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.

Blue Cross and Blue Shield
Blue options

Políticas de autorización de Blue Cross and Blue Shield
Blue options

Sitio web del proveedor: https://www.floridablue.com/
Planes de seguro aceptados: PPO Federal Exchange Behavioral

¿Se requiere una autorización previa?

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 Olive (Avality). Please contact 1-800-955-5692 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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Blue Distinction Transplant Program. For more information on transplant services, please contact your referring physician's office.

Blue Cross and Blue Shield
Federal plan

Políticas de autorización de Blue Cross and Blue Shield
Federal plan

Sitio web del proveedor: https://www.floridablue.com/
Planes de seguro aceptados: PPO Behavioral

¿Se requiere una autorización previa?

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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Blue Distinction Transplant Program. For more information on transplant services, please contact your referring physician's office.

Blue Cross and Blue Shield
Network Blue

Políticas de autorización de Blue Cross and Blue Shield
Network Blue

Sitio web del proveedor: https://www.floridablue.com/
Planes de seguro aceptados: PPO Behavioral

¿Se requiere una autorización previa?

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 Olive (Avality). Please contact 1-800-955-5692 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-855-243-3326 to obtain authorization.
Nicklaus Children's Hospital is also known as a Blue Distinction Center. Blue Distinction® Centers and Blue Distinction® Centers+ for Transplants offers a range of transplant services.


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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Blue Distinction Transplant Program. For more information on transplant services, please contact your referring physician's office.

Blue Cross and Blue Shield
of Florida Health Options, Inc.

Políticas de autorización de Blue Cross and Blue Shield
of Florida Health Options, Inc.

Sitio web del proveedor: https://www.floridablue.com/
Planes de seguro aceptados: HMO Behavioral

¿Se requiere una autorización previa?

MRI: YES*
CT Scans: YES*
PET: YES*
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: NO
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 Olive (Avality). Please contact 1-800-955-5692 to obtain authorization.
Nicklaus Children's Hospital is also known as a Blue Distinction Center. Blue Distinction® Centers and Blue Distinction® Centers+ for Transplants offers a range of transplant services.


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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Blue Distinction Transplant Program. For more information on transplant services, please contact your referring physician's office.

Blue Cross Blue Shield
Out of State

Políticas de autorización de Blue Cross Blue Shield
Out of State

Sitio web del proveedor: https://www.floridablue.com/
Planes de seguro aceptados: HMO PPO Behavioral

¿Se requiere una autorización previa?

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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Blue Distinction Transplant Program. For more information on transplant services, please contact your referring physician's office.

Children Medical Services- Sunshine

Políticas de autorización de Children Medical Services- Sunshine

Sitio web del proveedor: https://www.sunshinehealth.com/CMS
Planes de seguro aceptados: Medicaid

¿Se requiere una autorización previa?

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 (National Imaging Associates). Please contact 1-866-214-2569 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.

Cigna Healthcare

Políticas de autorización de Cigna Healthcare

Sitio web del proveedor: http://www.cigna.com/
Planes de seguro aceptados: HMO PPO Behavioral International

¿Se requiere una autorización previa?

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.

Community Care Plan

Políticas de autorización de Community Care Plan

Sitio web del proveedor: https://ccpcares.org/
Planes de seguro aceptados: Medicaid Healthy Kids

¿Se requiere una autorización previa?

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*

*Medicaid policies- not accepted at our Dan Marino or Miramar locations. Healthy Kid policies- not accepted at any of our facilities, except for Palm Beach Gardens. Please contact your health plan for in-network providers.


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.

Humana HMO

Políticas de autorización de Humana HMO

Sitio web del proveedor: https://www.humana.com/
Planes de seguro aceptados: HMO PPO Medicaid Behavioral

¿Se requiere una autorización previa?

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.

Humana Medicaid

Políticas de autorización de Humana Medicaid

Sitio web del proveedor: https://www.humana.com/
Planes de seguro aceptados: HMO PPO Medicaid Behavioral

¿Se requiere una autorización previa?

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: No Benefits


**Humana does require authorization for rehabilitate evaluations through HN1. Unfortunately, at this time Nicklaus Children's Hospital does not have a contract with HN1 except for our Palm Beach location. 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.

Humana PPO

Políticas de autorización de Humana PPO

Sitio web del proveedor: https://www.humana.com/
Planes de seguro aceptados: HMO PPO Medicaid Behavioral

¿Se requiere una autorización previa?

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.

Humana Tricare

Políticas de autorización de Humana Tricare

Sitio web del proveedor: https://www.mytricare.com/mtc/
Planes de seguro aceptados:

¿Se requiere una autorización previa?

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.

Medicaid of Florida

Políticas de autorización de Medicaid of Florida

Sitio web del proveedor: http://www.myflfamilies.com/service-programs/access-florida-food-medical-assistance-cash/medicaid
Planes de seguro aceptados: Medicaid

¿Se requiere una autorización previa?

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

*Please submit authorization through the eQSuite portal. http://fl.eqhs.org/
**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.

Molina Healthcare of Florida, Inc.

Políticas de autorización de Molina Healthcare of Florida, Inc.

Sitio web del proveedor: http://www.molinahealthcare.com/en-us/Pages/home.aspx
Planes de seguro aceptados: Federal Exchange Medicaid

¿Se requiere una autorización previa?

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: YES




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.

Simply Healthcare Plans, Inc.

Políticas de autorización de Simply Healthcare Plans, Inc.

Sitio web del proveedor: http://www.simplyhealthcareplans.com/
Planes de seguro aceptados: Medicaid Healthy Kids Behavioral

¿Se requiere una autorización previa?

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 1-877-202-5276 to obtain authorization.
**Simply does require authorization for rehabilitate evaluations through HN1. Unfortunately, at this time Nicklaus Children's Hospital does not have a contract with HN1 except for our Palm Beach location. Please verify with your health plan for an in network provider.
***Patients are unable to receive treatment at Nicklaus if 6 and over. 5 and under are able to seek treatment at our facility.


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.

Sunshine State Health Plan/Ambetter

Políticas de autorización de Sunshine State Health Plan/Ambetter

Sitio web del proveedor: https://www.sunshinehealth.com/
Planes de seguro aceptados: Federal Exchange Medicaid Behavioral

¿Se requiere una autorización previa?

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 (National Imaging Associates). 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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Sunshine BMT. For more information on transplant services, please contact your referring physician's office.

UMR

Políticas de autorización de UMR

Sitio web del proveedor: https://www.umr.com/tpa-ap-web/
Planes de seguro aceptados: HMO PPO Behavioral

¿Se requiere una autorización previa?

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.

United HMO-PPO

Políticas de autorización de United HMO-PPO

Sitio web del proveedor: https://www.myuhc.com/member/prewelcome.do
Planes de seguro aceptados: HMO PPO Federal Exchange Behavioral International

¿Se requiere una autorización previa?

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.
Nicklaus Children's Hospital is participating with the Optum Transplant network.


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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Optum. For more information on transplant services, please contact your referring physician's office.

United Medicaid

Políticas de autorización de United Medicaid

Sitio web del proveedor: https://www.myuhc.com/member/prewelcome.do
Planes de seguro aceptados: Medicaid Behavioral

¿Se requiere una autorización previa?

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.


Transplant Policies

Nicklaus Children's Hospital is in network with the health plan's corresponding transplant ​network, Optum. For more information on transplant services, please contact your referring physician's office.

Virgin Islands Medicaid Program

Políticas de autorización de Virgin Islands Medicaid Program

Sitio web del proveedor: http://www.dhs.gov.vi/financial_programs/medical_assistance.html
Planes de seguro aceptados: Medicaid International

¿Se requiere una autorización previa?

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.