Insurance List | Nicklaus Children's Hospital

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.

Aetna Better Health, Inc
Aetna U.S. Healthcare, Inc
Ambetter Health
AmeriHealth Caritas
AvMed Health Plan
Best Doctors, Inc.
Blue Cross and Blue Shield Blue Options/Network Blue
Blue Cross and Blue Shield Federal plan
Blue Cross and Blue Shield My Blue
Blue Cross and Blue Shield of Florida Health Options, Inc.
Blue Cross Blue Shield PPO
Children Medical Services- Sunshine
Cigna Healthcare
Community Care Plan
First Health
Humana HMO
Humana Medicaid
Humana PPO
Medicaid of Florida
Molina Healthcare of Florida, Inc.
Multiplan
Simply Healthcare Plans, Inc.
Staywell-Wellcare Medicaid
Sunshine State Health Plan
Tricare
UMR
UnitedHealthcare HMO-PPO
UnitedHealthcare Medicaid
Vivida Health

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

Speech Evaluation: YES**

Feeding and Swallowing Evaluation: YES**

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

Lab Information

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

Aetna U.S. Healthcare, Inc

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

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.

Ambetter Health

Health Provider Website: ambetterhealth.com
Accepted Health Plans: Federal Exchange

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES*

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by National Imaging Management (NIA). Please contact 1-800-214-2569 to obtain authorization.

AmeriHealth Caritas

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

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

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

AvMed Health Plan

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

Best Doctors, Inc.

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

Does the diagnostic service require prior authorization?

MRI: CALL

CT Scans: CALL

PET: CALL

X-rays: CALL

Polysonograms: CALL

Ultrasounds: CALL

Physical Therapy: CALL

Occupational Therapy: CALL

Audio Evaluation: CALL

Speech Evaluation: CALL

Feeding and Swallowing Evaluation: CALL

International Policies

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/Network Blue

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

Blue Cross and Blue Shield
Federal plan

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

Does the diagnostic service require prior authorization?

MRI: NO

CT Scans: NO

PET: NO

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

Blue Cross and Blue Shield
My Blue

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

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

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES

Ultrasounds: YES

Physical Therapy: YES

Occupational Therapy: YES

Audio Evaluation: YES

Speech Evaluation: YES

Feeding and Swallowing Evaluation: YES

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

Lab Information

Blue Cross Blue Shield
PPO

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

Does the diagnostic service require prior authorization?

MRI: CALL*

CT Scans: CALL*

PET: CALL*

X-rays: CALL

Polysonograms: CALL

Ultrasounds: CALL

Physical Therapy: CALL

Occupational Therapy: CALL

Audio Evaluation: CALL

Speech Evaluation: CALL

Feeding and Swallowing Evaluation: CALL

*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

Children Medical Services- Sunshine

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

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

Cigna Healthcare

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

International Policies

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

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

First Health

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

Does the diagnostic service require prior authorization?

MRI: CALL*

CT Scans: CALL*

PET: CALL*

X-rays: CALL*

Polysonograms: CALL*

Ultrasounds: CALL*

Physical Therapy: CALL*

Occupational Therapy: CALL*

Audio Evaluation: CALL*

Speech Evaluation: CALL*

Feeding and Swallowing Evaluation: CALL*

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

Humana HMO

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

Humana Medicaid

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

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: YES

Polysonograms: YES

Ultrasounds: YES

Physical Therapy: YES**

Occupational Therapy: YES**

Audio Evaluation: YES

Speech Evaluation: YES**

Feeding and Swallowing Evaluation: YES**

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

Lab Information

Humana PPO

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

Medicaid of Florida

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

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: NO

Polysonograms: NO

Ultrasounds: NO*

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

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

Molina Healthcare of Florida, Inc.

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

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: NO

Polysonograms: YES*

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

Multiplan

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

Does the diagnostic service require prior authorization?

MRI: CALL

CT Scans: CALL

PET: CALL

X-rays: CALL

Polysonograms: CALL

Ultrasounds: CALL

Physical Therapy: CALL

Occupational Therapy: CALL

Audio Evaluation: CALL

Speech Evaluation: CALL

Feeding and Swallowing Evaluation: CALL

Simply Healthcare Plans, Inc.

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES

Ultrasounds: NO

Physical Therapy: YES**

Occupational Therapy: YES**

Audio Evaluation: NO

Speech Evaluation: YES**

Feeding and Swallowing Evaluation: YES

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

Lab Information

Staywell-Wellcare Medicaid

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

Sunshine State Health Plan

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

Tricare

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

Does the diagnostic service require prior authorization?

MRI: CALL

CT Scans: CALL

PET: CALL

X-rays: CALL

Polysonograms: CALL

Ultrasounds: CALL

Physical Therapy: CALL

Occupational Therapy: CALL

Audio Evaluation: CALL

Speech Evaluation: CALL

Feeding and Swallowing Evaluation: CALL

Lab Information

UMR

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

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: NO

Polysonograms: CALL

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

UnitedHealthcare HMO-PPO

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: YES**

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

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

Lab Information

International Policies

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

UnitedHealthcare Medicaid

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

Does the diagnostic service require prior authorization?

MRI: YES*

CT Scans: YES*

PET: YES*

X-rays: NO

Polysonograms: NO

Ultrasounds: NO

Physical Therapy: YES**

Occupational Therapy: YES**

Audio Evaluation: NO

Speech Evaluation: YES**

Feeding and Swallowing Evaluation: YES**

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

Lab Information

Vivida Health

Health Provider Website: vividahealth.com
Accepted Health Plans: Medicaid

Does the diagnostic service require prior authorization?

MRI: YES

CT Scans: YES

PET: YES

X-rays: NO

Polysonograms: YES

Ultrasounds: NO

Physical Therapy: NO

Occupational Therapy: NO

Audio Evaluation: NO

Speech Evaluation: NO

Feeding and Swallowing Evaluation: NO

Lab Information

This page was last updated on : 11/23/2022 6:37:21 AM.

Accepted Health Plans/Insurance

Contact Us

Aetna Better Health, Inc

Does the diagnostic service require prior authorization?

Lab Information

Aetna U.S. Healthcare, Inc

Does the diagnostic service require prior authorization?

Lab Information

International Policies

Ambetter Health

Does the diagnostic service require prior authorization?

AmeriHealth Caritas

Does the diagnostic service require prior authorization?

Lab Information

AvMed Health Plan

Does the diagnostic service require prior authorization?

Lab Information

Best Doctors, Inc.

Does the diagnostic service require prior authorization?

International Policies

Blue Cross and Blue Shield Blue Options/Network Blue

Does the diagnostic service require prior authorization?

Lab Information

Blue Cross and Blue Shield Federal plan

Does the diagnostic service require prior authorization?

Lab Information

Blue Cross and Blue Shield My Blue

Does the diagnostic service require prior authorization?

Lab Information

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

Does the diagnostic service require prior authorization?

Lab Information

Blue Cross Blue Shield PPO

Does the diagnostic service require prior authorization?

Lab Information

Children Medical Services- Sunshine

Does the diagnostic service require prior authorization?

Lab Information

Cigna Healthcare

Does the diagnostic service require prior authorization?

Lab Information

International Policies

Community Care Plan

Does the diagnostic service require prior authorization?

Lab Information

First Health

Does the diagnostic service require prior authorization?

Humana HMO

Does the diagnostic service require prior authorization?

Lab Information

Humana Medicaid

Does the diagnostic service require prior authorization?

Lab Information

Humana PPO

Does the diagnostic service require prior authorization?

Lab Information

Medicaid of Florida

Does the diagnostic service require prior authorization?

Lab Information

Molina Healthcare of Florida, Inc.

Does the diagnostic service require prior authorization?

Lab Information

Multiplan

Does the diagnostic service require prior authorization?

Simply Healthcare Plans, Inc.

Does the diagnostic service require prior authorization?

Lab Information

Staywell-Wellcare Medicaid

Does the diagnostic service require prior authorization?

Lab Information

Sunshine State Health Plan

Does the diagnostic service require prior authorization?

Lab Information

Tricare

Does the diagnostic service require prior authorization?

Lab Information

UMR

Does the diagnostic service require prior authorization?

Lab Information

UnitedHealthcare HMO-PPO

Blue Cross and Blue Shield
Blue Options/Network Blue

Blue Cross and Blue Shield
Federal plan

Blue Cross and Blue Shield
My Blue

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

Blue Cross Blue Shield
PPO