Managed Care Notice

Information for patient families covered by Sunshine Health Medicaid Managed Care (MMA) or Healthy Kids plans

After months of discussion with Sunshine Health, we have not been able to reach a new agreement. As of January 2, 2018, Sunshine Health will consider hospital-based services and provider (physician) services at Johns Hopkins All Children’s Hospital as out-of-network.

We continue to reach out to Sunshine Health in an effort to come to an agreement.

Here are things you should know about your child’s coverage and care: 

  • If your child is already an inpatient at Johns Hopkins All Children’s Hospital on January 2, 2018: The hospital stay and physician services will be covered in-network for at least 60 days, and up to 6 months, until your child is discharged or until the insurance company makes the decision that your child should be transferred (or discharged) to another provider.   
  • If your child is already in active treatment at Johns Hopkins All Children’s Hospital or a Johns Hopkins All Children’s Outpatient Care facility for a chronic or acute health condition as of January 2, 2018: Your child has the right to continue these visits for up to 6 months.  Please call our special Johns Hopkins All Children’s information line (see below) for more information.
  • If your child has been receiving primary (general) pediatric care from the Pediatric & Adolescent Medicine program at Johns Hopkins All Children’s in St. Petersburg or Dr. Patricia Blanco/Dr. Skidmore at Johns Hopkins All Children’s Outpatient Care/Sarasota: The practice office can help you communicate with Sunshine to request that your child’s care continues with this group.
  • If your child has an appointment scheduled during the next few months: We hope that you don’t cancel the appointment yet. This may help avoid a delay in rescheduling later. Please call us to discuss your coverage.
  • For pregnant patients currently receiving prenatal care, regardless of the trimester in which care began, coverage will continue through delivery and completion of postpartum care.
  • For pregnant patients If your child is done with treatment for now and needs our services again in the future: Our scheduling team and/or managed care office will be happy to discuss your options at that time.
  • If your child is scheduled for a new appointment as a new patient on or after January 2, 2018: Sunshine Health will consider the visit as an out-of-network service. You may call Sunshine to discuss the coverage options available to you under your plan.
  • If one of our physicians is treating your child as an inpatient at an affiliate community hospital where they have medical staff privileges: The physician services for your child’s care will be covered as in-network for the duration of the current inpatient stay.  

Call Us to Ask a Question

You should call Sunshine Health to get specific information about your options. In addition, we are happy to answer your questions and discuss concerns about coverage for services at Johns Hopkins All Children’s Hospital.

We have set up a special telephone line to assist you. Please call 727-767-8284 or 1-800-456-4543, ext. 78284, between 8:00 a.m. and 6:00 p.m. Monday through Friday to reach one of our staff members. If you get voicemail, leave a message with your daytime contact information and we will return your call the next business day.
 

Call 727-767-8284 for more Information

 

Answers to More Questions

Why did I get a letter from Johns Hopkins All Children's Hospital about my child’s Sunshine Health insurance?

It’s normal business practice for hospitals and health insurers to renew/renegotiate contracts every few years. We’ve been working on this with Sunshine Health for many months and, unfortunately, have not been able to reach a new agreement. We hope to continue these conversations and find a solution.

What providers are in my network that you would recommend?

We encourage you to call Sunshine Health to explain your child’s specific health care needs and ask them to provide a list of in-network providers.
If there’s no in-network provider available, we’ll help you understand your options and how to ask Sunshine for authorization to continue treatment at Johns Hopkins All Children’s.

I want my child to continue to receive care at Johns Hopkins All Children’s All. What can I do?

You can ask Sunshine for authorization to continue Medically Necessary care for a high-risk condition. You can also talk to Johns Hopkins All Children’s about how to apply for financial assistance. Call 727-767-8284 to learn more about Financial Assistance.

Can I change my child’s health insurance? 

There are two times a year when the State of Florida allows any Medicaid MMA/HMO enrollee to change plans:

  • In the first 120 days after enrollment
  • Once a year, during a 60-day period at the anniversary of enrollment—you will get a letter in the mail about this open enrollment

You can learn more at http://www.flmedicaidmanagedcare.com/MMA/FAQ.aspx or call 1-877-711-3662 to talk to a Florida Agency for Healthcare Administration MMA choice counselor.

The state of Florida also lets MMA participants request a change in their plan due to a “state-approved good cause.” Call 1-877-711-3662 to learn more about such requests.

At this time, Johns Hopkins All Children’s and  its physicians also participate in these MMA plans: 

  • Amerigroup
  • BetterHealth
  • Humana
  • Molina
  • Simply
  • Staywell/WellCare
  • United Healthcare Community Plan

Who can I contact with concerns about my or my child’s coverage?

We urge you to reach out to Sunshine Health to share your concerns.

We are happy to answer your questions and discuss concerns. We have set up a special telephone line for these calls:  727-767-8284 or 1-800-456-4543, ext. 78284. Please call between 8:00 a.m. and 6:00 p.m. Monday through Friday to speak with one of our staff members. If you get voicemail, leave a message with your daytime contact information and we will return your call the next business day.