Referidos de Proveedores de Salud y Solicitud de Autorización de Información

Referidos versus Autorización Previa

El referido es el proceso de enviar un paciente a donde otro profesional (por ejemplo, a un especialista) para una consulta o para un servicio de atención de salud, que la fuente de referencia considera necesario, pero que no está preparada o calificada para proveer. Su médico de atención primaria lo remitirá donde un especialista participante o a un proveedor de servicio de atención de salud, si él o ella no puede proporcionar personalmente la atención que usted necesita. Muchos referidos no necesitan un número de autorización.

La autorización, también conocida como pre-certificación, es un proceso de revisión de ciertos servicios médicos, quirúrgicos o de salud del comportamiento, para estar seguros de las necesidades médicas y de la atención apropiada antes de que se proporcionen los servicios. La revisión también incluye una determinación sobre si el servicio que se solicita está cubierto bajo su plan de beneficios. Las autorizaciones son requeridas únicamente para ciertos servicios. Su médico someterá la solicitud de autorización/pre-certificación electrónicamente, por teléfono o escribiendo un fax o un correo electrónico.

¿Qué hacer después?

Si el estudio que su hijo va a recibir requiere de autorización, por favor póngase en contacto con el proveedor de salud que ordena el estudio para que le proporcione los detalles de la cita (fecha/hora de la cita) para que empiece el proceso de autorización; a menos que su plan de seguro exija la autorización del médico primario, en cuyo caso, por favor póngase en contacto con su médico primario para solicitar una autorización.

Por favor a continuación haga clic en el plan de salud deseado, para verificar si se requiere una autorización previa a través de su plan de salud para los servicios de diagnóstico ambulatorio más comunes. Cualquier servicio que no esté listado en el enlace, por favor póngase en contacto con la Unidad de Autorización llamando al 786-624-3022 para más información.

*Por favor tenga en cuenta que la información que se indica es general y que cada plan de grupo puede tener requisitos distintos que no encuadran dentro de estos lineamientos. Para enterarse sobre requisitos específicos, por favor contacte directamente su plan de salud.

Políticas de autorización de Aetna Better Health, Inc

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

¿Se requiere una autorización previa?

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

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


Lab Information

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

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

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

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-800-792-8744 to obtain authorization.
** Authorizations for Polysomnograms are issued by Evicore. Please contact 1-800-792-8744 to obtain authorization.


Lab Information

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


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

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

Políticas de autorización de AmeriHealth Caritas

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

¿Se requiere una autorización previa?

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




Lab Information

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

Políticas de autorización de AvMed Health Plan

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

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Evicore. Please contact 1-800-792-8744 to obtain authorization.


Lab Information

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

Políticas de autorización de Best Doctors, Inc.

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

¿Se requiere una autorización previa?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

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

Políticas de autorización de Blue Cross and Blue Shield
Blue options

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

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Olive (Avality). Please contact 1-800-955-5692 to obtain authorization.
**Authorizations for polysonogram studies are issued by Care Centrex. Please contact 1-855-243-3326 to obtain authorization.


Lab Information

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


Transplant Policies

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

Políticas de autorización de Blue Cross and Blue Shield
Federal plan

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

¿Se requiere una autorización previa?

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




Lab Information

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


Transplant Policies

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

Políticas de autorización de Blue Cross and Blue Shield
Network Blue

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

¿Se requiere una autorización previa?

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

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


Lab Information

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


Transplant Policies

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

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

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

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by Olive (Avality). Please contact 1-800-955-5692 to obtain authorization.
Nicklaus Children's Hospital is also known as a Blue Distinction Center. Blue Distinction® Centers and Blue Distinction® Centers+ for Transplants offers a range of transplant services.


Lab Information

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


Transplant Policies

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

Políticas de autorización de Blue Cross Blue Shield
Out of State

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

¿Se requiere una autorización previa?

MRI: Call*
CT Scans: CALL*
PET: CALL*
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL

*Authorizations for high-end imaging (MRI, CT, PET Scans) are usually handled by a third party. Please contact the health plan directly for specifics regarding authorization submission.
Out of state policies differ in authorization requirements dependent on the state. For all authorization requirements done in an outpatient hospital setting, please contact the health plan for details.


Lab Information

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


Transplant Policies

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

Políticas de autorización de Children Medical Services- Sunshine

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

¿Se requiere una autorización previa?

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

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


Lab Information

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

Políticas de autorización de Cigna Healthcare

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

¿Se requiere una autorización previa?

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

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


Lab Information

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


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

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

Políticas de autorización de Community Care Plan

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

¿Se requiere una autorización previa?

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

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


Lab Information

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

Políticas de autorización de Humana HMO

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

¿Se requiere una autorización previa?

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

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


Lab Information

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

Políticas de autorización de Humana Medicaid

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

¿Se requiere una autorización previa?

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


**Humana does require authorization for rehabilitate evaluations through HN1. Unfortunately, at this time Nicklaus Children's Hospital does not have a contract with HN1 except for our Palm Beach location. Please verify with your health plan for an in network provider.


Lab Information

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

Políticas de autorización de Humana PPO

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

¿Se requiere una autorización previa?

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

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


Lab Information

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

Políticas de autorización de Humana Tricare

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

¿Se requiere una autorización previa?

MRI: CALL
CT Scans: CALL
PET: CALL
X-rays: CALL
Polysonograms: CALL
Ultrasounds: CALL
Physical Therapy: CALL
Occupational Therapy: CALL
Audio Evaluation: CALL
Speech Evaluation: CALL
Feeding and Swallowing Evaluation: CALL




Lab Information

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

Políticas de autorización de Medicaid of Florida

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

¿Se requiere una autorización previa?

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

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


Lab Information

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

Políticas de autorización de Molina Healthcare of Florida, Inc.

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

¿Se requiere una autorización previa?

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




Lab Information

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

Políticas de autorización de Simply Healthcare Plans, Inc.

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

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by American Imagining Management (AIM). Please contact 1-877-202-5276 to obtain authorization.
**Simply does require authorization for rehabilitate evaluations through HN1. Unfortunately, at this time Nicklaus Children's Hospital does not have a contract with HN1 except for our Palm Beach location. Please verify with your health plan for an in network provider.
***Patients are unable to receive treatment at Nicklaus if 6 and over. 5 and under are able to seek treatment at our facility.


Lab Information

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

Políticas de autorización de Sunshine State Health Plan/Ambetter

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

¿Se requiere una autorización previa?

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

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


Lab Information

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


Transplant Policies

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

Políticas de autorización de UMR

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

¿Se requiere una autorización previa?

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




Lab Information

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

Políticas de autorización de United HMO-PPO

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

¿Se requiere una autorización previa?

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

*Authorizations for high-end imaging (MRI, CT, PET Scans) are issued by United Healthcare. Please contact 1-866-889-8054 to obtain authorization.
Nicklaus Children's Hospital is participating with the Optum Transplant network.


Lab Information

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


International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

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


Transplant Policies

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

Políticas de autorización de United Medicaid

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

¿Se requiere una autorización previa?

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

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


Lab Information

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


Transplant Policies

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

Políticas de autorización de Virgin Islands Medicaid Program

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

¿Se requiere una autorización previa?

MRI: YES
CT Scans: YES
PET: YES
X-rays: YES
Polysonograms: YES
Ultrasounds: YES
Physical Therapy: YES
Occupational Therapy: YES
Audio Evaluation: YES
Speech Evaluation: YES
Feeding and Swallowing Evaluation: YES




International Policies

International policies require a verification of benefits letter (VOB) from the health plan confiriming eligibility and coverage for the desired services. Please contact your health plan directly in order to verify coverage.

Nicklaus Children's Hospital offers a Global concierge service, in which International patients can experience world renowned and comprehensive service. The Global Department will be able to help facilitate all of your healthcare needs.

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