Accepted Health Plans and Insurance Providers

Nicklaus Children's Hospital is a preferred pediatric provider for most major South Florida health insurance plans. For parents, this means that your health insurance program is likely to cover the specialized pediatric care provided by Nicklaus Children's Hospital - the only pediatric hospital in South Florida dedicated exclusively to children.

We are committed to providing our pediatric patients with the highest level of care in cooperation with today's managed care environment. Our Managed Care department works closely with HMOs, PPOs and other health plans to track patient care and monitor outcomes.

Below we have outlined the most common health plans Nicklaus Children’s Hospital participates with, alongside each insurance's respective authorization requirements for the most common diagnostic studies. Authorization requirements vary by each plan/group and the below should be used as a guide. Please contact your health plan directly to verify if your insurance plan is participating with Nicklaus Children’s and to verify authorization requirements as some insurance plans utilize narrow networks which may exclude our facility.

Contact Us
Authorization Unit
786-624-3022


Please note that some non-employed physicians and credentialed medical staff members of Nicklaus Children's Hospital may not accept all of the health plans listed below. Also note that participation in these plans is not a guarantee of payment or coverage.

Aetna Better Health, Inc

Authorization Policies for Aetna Better Health, Inc

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES
Ultrasound: NO
Physical therapy: No Benefits
Occupational Therapy: No Benefits
Audio Evaluation: No Benefits
Speech Evaluation: No Benefits
Feeding & Swallowing Evaluation: No Benefits

*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: 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

Authorization Policies for Aetna U.S. Healthcare, Inc

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES**
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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 confirming 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

Authorization Policies for AmeriHealth Caritas

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

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for AvMed Health Plan

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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.

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-Ray: CALL
Polysonogram: CALL
Ultrasound: CALL
Physical therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding & Swallowing Evaluation: CALL




Blue Cross and Blue Shield
Blue options

Authorization Policies for Blue Cross and Blue Shield
Blue options

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES**
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Olive (Availity). 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

Authorization Policies for Blue Cross and Blue Shield
Federal plan

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

Does the diagnostic service require prior authorization?

MRI: NO
CT Scans: NO
PET: NO
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for Blue Cross and Blue Shield
Network Blue

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES**
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & Swallowing Evaluation: NO

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Olive (Availity). 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.

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

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: YES
Polysonogram: YES
Ultrasound: YES
Physical therapy: NO
Occupational Therapy: YES
Audio Evaluation: NO
Speech Evaluation: YES
Feeding & Swallowing Evaluation: YES

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Olive (Availity). 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

Authorization Policies for Blue Cross Blue Shield
Out of State

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

Does the diagnostic service require prior authorization?

MRI: Call*
CT Scans: CALL*
PET: CALL*
X-Ray: CALL
Polysonogram: CALL
Ultrasound: CALL
Physical therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding & 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

Authorization Policies for Children Medical Services- Sunshine

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for Cigna Healthcare

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES**
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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 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 confirming 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

Authorization Policies for Community Care Plan

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

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO*
Occupational Therapy: NO*
Audio Evaluation: NO
Speech Evaluation: NO*
Feeding & 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

Authorization Policies for Humana HMO

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

Does the diagnostic service require prior authorization?

CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for Humana Medicaid

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

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-Ray: YES
Polysonogram: YES
Ultrasound: YES
Physical therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: YES
Speech Evaluation: YES**
Feeding & 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

Authorization Policies for Humana PPO

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

Does the diagnostic service require prior authorization?

CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for Humana 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-Ray: CALL
Polysonogram: CALL
Ultrasound: CALL
Physical therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding & 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

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-Ray: NO
Polysonogram: NO
Ultrasound: NO**
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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.

Authorization Policies for Molina Healthcare of Florida, Inc.

Health Provider Website: http://www.molinahealthcare.com/en-us/Pages/home.aspx
Accepted Health Plans: Federal Exchange Medicaid

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-Ray: YES
Polysonogram: YES
Ultrasound: YES
Physical therapy: No Benefits
Occupational Therapy: No Benefits
Audio Evaluation: YES
Speech Evaluation: No Benefits
Feeding & 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.

Authorization Policies for Simply Healthcare Plans, Inc.

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES
Ultrasound: NO
Physical therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: NO***
Speech Evaluation: YES**
Feeding & 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

Authorization Policies for Sunshine State Health Plan/Ambetter

Health Provider Website: https://www.sunshinehealth.com/
Accepted Health Plans: Federal Exchange Medicaid Behavioral

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for UMR

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

Does the diagnostic service require prior authorization?

MRI: YES
CT Scans: YES
PET: YES
X-Ray: NO
Polysonogram: CALL
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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

Authorization Policies for United HMO-PPO

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: YES
Ultrasound: NO
Physical therapy: NO
Occupational Therapy: NO
Audio Evaluation: NO
Speech Evaluation: NO
Feeding & 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 confirming 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

Authorization Policies for United Medicaid

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

Does the diagnostic service require prior authorization?

MRI: YES*
CT Scans: YES*
PET: YES*
X-Ray: NO
Polysonogram: NO
Ultrasound: NO
Physical therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: NO
Speech Evaluation: YES**
Feeding & 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

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-Ray: YES
Polysonogram: YES
Ultrasound: YES
Physical therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding & Swallowing Evaluation: YES




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confirming 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.