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.
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.
Health Provider Website: https://www.aetnabetterhealth.com/florida Accepted Health Plans: Medicaid Healthy Kids
*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.
Preferred Independent Lab: LabCorp or Quest DiagnosticsLaboratory 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.
Health Provider Website: https://www.aetna.com/ Accepted Health Plans: HMO PPO International
*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.
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.
Health Provider Website: https://www.avmed.org/ Accepted Health Plans: HMO PPO
*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.
Preferred Independent Lab: Quest DiagnosticsLaboratory 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.
Health Provider Website: http://www.bestdoctors.com/ Accepted Health Plans: International
Health Provider Website: https://www.floridablue.com/ Accepted Health Plans: PPO
Health Provider Website: https://www.floridablue.com/ Accepted Health Plans: PPO Federal Exchange
*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.
Health Provider Website: https://www.floridablue.com/ Accepted Health Plans: HMO Federal Exchange
*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.
Health Provider Website: https://www.floridablue.com/ Accepted Health Plans: HMO PPO
*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.
Health Provider Website: http://www.cigna.com/ Accepted Health Plans: HMO PPO International
*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.
Health Provider Website: https://ccpcares.org/ Accepted Health Plans: Medicaid Healthy Kids
**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.
Health Provider Website: https://providerlocator.firsthealth.com/ Accepted Health Plans: PPO
*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.
Health Provider Website: https://www.humana.com/ Accepted Health Plans: HMO PPO
*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Health Help. Please contact 1-866-825-1550 to obtain authorization.
Health Provider Website: https://www.humana.com/ Accepted Health Plans: HMO PPO Medicaid
**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.
Health Provider Website: http://www.myflfamilies.com/service-programs/access-florida-food-medical-assistance-cash/medicaid Accepted Health Plans: Medicaid
*Only pelvic ultrasounds require authorization. Please submit authorization through the eQSuite portal. http://fl.eqhs.org/
Preferred Independent Lab: LabCorp, Quest or Physician PrescriptionLaboratory 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.
Health Provider Website: https://www.miamichildrenshealthplan.com/ Accepted Health Plans: Medicaid
Health Provider Website: https://www.molinahealthcare.com/members/fl/en-US/pages/home.aspx Accepted Health Plans: Medicaid
**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.
Health Provider Website: https://www.multiplan.com Accepted Health Plans: PPO
Health Provider Website: https://www.prestigehealthchoice.com/ Accepted Health Plans: Medicaid
Health Provider Website: http://www.simplyhealthcareplans.com/ Accepted Health Plans: Medicaid Healthy Kids
*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.
Preferred Independent Lab: LabCorpLaboratory 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.
Health Provider Website: https://www.sunshinehealth.com/ Accepted Health Plans: Medicaid
*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by NIA Please contact 1-866-214-2569 to obtain authorization.
Health Provider Website: https://www.mytricare.com/mtc/ Accepted Health Plans:
Health Provider Website: https://www.myuhc.com/member/prewelcome.do Accepted Health Plans: HMO PPO International
*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.
Health Provider Website: https://www.myuhc.com/member/prewelcome.do Accepted Health Plans: Medicaid
*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.
Health Provider Website: http://www.dhs.gov.vi/financial_programs/medical_assistance.html Accepted Health Plans: Medicaid International
Health Provider Website: https://www.wellcare.com/Florida Accepted Health Plans: Medicaid
*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.
This page was last updated on : 2/24/2021 1:17:47 AM.