Accepted Health Plans/Insurance

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

The Authorization Unit can can contacted at 786-624-3022 as well as Managed Care at 305-669-5834 for further clarification.


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 above. Also note that participation in these plans is not a guarantee of payment or coverage.


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
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 or South Florida Musculoskeletal. Unfortunately, at this time NCH does not have a contract with neither provider. 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.


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
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.


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
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.


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
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

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
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.


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
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.


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
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.


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
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.


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
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.


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
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.


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
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

Health Provider Website: https://ccpcares.org/
Accepted Health Plans: HMO 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: YES*
Occupational Therapy: YES*
Audio Evaluation: NO
Audio Evaluation: NO
Speech Evaluation: YES*
Feeding and Swallowing Evaluation: YES*


**Please note CCP 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: 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.


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
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.


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*
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.


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
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

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
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.


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
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.


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
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.


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
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.


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: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES**
Occupational Therapy: YES**
Audio Evaluation: YES
Audio Evaluation: YES
Speech Evaluation: YES**
Feeding and Swallowing Evaluation: YES



**Please note Molina 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: 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.


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
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL





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
Audio Evaluation: YES
Speech Evaluation: No Benefits
Feeding and Swallowing Evaluation: No Benefits





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
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.


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***
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.
***Medicaid patients that are 7 and older CANNOT be seen at NCH and must utilize a 20/20 hearing provider. Patients 6 and under can be seen at NCH. Healthy Kids patients CANNOT be seen at NCH and must utilize a Hear USA provider. 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.


Staywell-Wellcare

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
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.


Sunshine State Health Plan

Health Provider Website: https://www.sunshinehealth.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
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.


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
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.


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
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

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
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.


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
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.


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
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.


This page was last updated on : 9/11/2020 10:38:07 AM.