UnitedHealthcare of Florida
Nemours Children’s is committed to improving the health and well-being of the children and families we serve. An important part of that commitment is maintaining strong partnerships to ensure patients can access the high-quality, specialized care we provide.
Some patient families have received a communication notifying them of discussions currently underway between Nemours and UnitedHealthcare of Florida, Inc., and UnitedHealthcare Insurance Company (UnitedHealthcare). As Nemours works diligently to reach a fair and equitable agreement with UnitedHealthcare, we have launched this online resource to provide our patient families with the latest information.
Important Things to Know:
- Our top priority is ensuring that our patients can access the high-quality, specialized care we provide.
- These negotiations impact patients who receive care by a Nemours clinician in Florida and have Medicaid or commercial UnitedHealthcare coverage.
- For dates of service prior to July 1, 2024, patients can continue to see their Nemours provider without any changes.
- This potential termination applies to care and services delivered by Nemours physicians at all locations throughout the state of Florida, including primary care and our partner facilities.
- Our relationship with UnitedHealthcare does not impact your ability to seek emergency medical care.
- Nemours has relationships with other commercial and Medicaid insurance companies. See a list of accepted insurances by Nemours.
- These negotiations do not impact care provided by Nemours clinicians outside of Florida.
Key Dates:
- If an agreement is not reached, effective July 1, 2024, Nemours Children’s Health will not be a participating provider with UnitedHealthcare in Florida.
- Nemours can continue to see new and established Medicaid and commercial UnitedHealthcare patients until June 30, 2024.
- A Nemours provider may potentially be able to continue to treat your child if they are in an active treatment plan that is estimated to go beyond July 1, 2024. To determine if your child’s care might qualify, parents/guardians must contact UnitedHealthcare and request that the services in this treatment plan extend beyond July 1, 2024. Parents/guardians may be asked by UnitedHealthcare to complete a Continuity of Care form, depending on their type of coverage, and will be notified by UnitedHealthcare if their care qualifies.
- Nemours patients currently in active treatment may potentially be able to continue their care up to Dec. 31, 2024, if their care qualifies.
- Continuity of Care forms should be submitted as soon as possible and no later than June 30, 2024.
How do I know if my child may qualify for continued care beyond June 30, 2024?
- Examples of medical conditions that may qualify for continued care, include, but are not limited to:
- Coverage for newborn children for 30 days following birth. You must select an in-network pediatrician by June 30, 2024.
- Newly diagnosed or relapsed cancer patients currently receiving chemotherapy, radiation therapy or reconstruction.
- Transplant candidates or recipients in need of ongoing care due to complications associated with a transplant.
- Recent major surgeries in the acute phase and follow-up period (generally six — eight weeks after surgery).
- Serious acute conditions in active treatment.
- Other serious chronic conditions that require active treatment.
- Examples of conditions that do not qualify for continued care include:
- Routine exams, vaccinations and health assessments.
- Chronic conditions such as diabetes, arthritis, allergies, asthma, kidney disease and hypertension that are stable.
- Minor illnesses such as colds, sore throats and ear infections.
- Elective scheduled surgeries.
How do I apply for continued care if I think my child’s situation might apply?
A Nemours provider may potentially be able to continue to treat your child if they are in an active treatment plan that is estimated to go beyond July 1, 2024. To determine if your child’s care might qualify, parents/guardians must contact UnitedHealthcare and request that the services in this treatment plan extend beyond July 1, 2024. Parents/guardians may be asked by UnitedHealthcare to complete a Continuity of Care form, depending on their type of coverage, and will be notified by UnitedHealthcare if their care qualifies.
- If Nemours is required to complete a section of the form, please visit the Nemours app to upload and send to your provider.
- If you don’t have the Nemours app, please call us at (833)- 921-1242 so we can provide you with the appropriate fax number to send in your form.
- You can also drop your form off at your clinician’s location.
What You Can Do Now:
- Find the phone number for UnitedHealthcare member services on the back of your insurance ID card.
- Contact UnitedHealthcare member services to inform them of your child’s medical needs and emphasize that you wish to continue your child’s treatment with a Nemours provider.
For Additional Information
We will continue to update this website as our discussions with UnitedHealthcare continue.
If you have additional questions, contact Nemours at (833) 921-1242