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Sunshine Health FAQs

Answers to Additional Questions Families May Have

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

It’s normal business practice for hospitals and health plans to renew/renegotiate their contracts every few years. Insurers are required by law to let customers know 30 days before a possible plan change. Even though we are still in negotiations, Sunshine sent you a letter saying that Johns Hopkins All Children’s will not be a plan provider for 2018.

We want you to know that we are still a Sunshine Health provider through December 31, 2017 and we are working hard to reach an agreement with Sunshine. We sent you a letter to tell you that your child is covered through the end of the year and to tell you that there are rules about continuity of care to protect current treatment from being interrupted on December 31.

What if I my child has an appointment scheduled before December 31?

If the appointment is scheduled for November or December 2017, the treatment will be covered. At your appointment we may schedule follow-up visits that will take place after December 31 because we expect to finalize a new agreement.

What if my child has an appointment scheduled after December 31?

We will keep the appointment on our schedule. We believe patients in active treatment for a chronic or acute health condition and receiving outpatient services (for example physician visits, rehab visits) should continue to be covered by Sunshine for up to 6 months under the Continuity of Care. If anything changes that may impact your appointment and your benefits coverage we will call you before the appointment. We encourage you to call Sunshine Health directly to discuss the specifics of your plan.

What if I need to schedule a new appointment after December 31?

You should call the insurance company to discuss your options under the plan.

What providers are in my network that you would recommend?

We encourage you to call your insurance company to give you a list of network providers. If there’s no network provider available, we’ll help you understand your options and we can talk to your insurance company about getting authorization for treatment here as “out-of-network.”

I want my child to continue to receive care from Johns Hopkins All Children's Hospital.  What can I do?

We hope to have a new agreement in place before January 1. The letter we sent to families was to let you know that the negotiation process is underway.
 
We believe patients who are in active treatment for a chronic or acute health condition and receiving outpatient services (for example physician visits, rehab visits) will continue to be covered as in-network for up to 6 months under the Continuity of Care.
 
If we are unable to reach a new agreement by December 31, 2017, we will send another letter and also posted the notice on this page on our website (www.HopkinsAllChildrens.org/mcnotice).

My child will is expected to be an inpatient at Johns Hopkins All Children's Hospital on December 31, 2017.  What will happen?

The hospital stay and physician services will be covered as an in-network for up to 6 months until you or your child is discharged or your insurance company makes the decision that you or your child should be transferred (or discharged to) another provider. We hope to reach a new agreement before December 31. If we are unable to reach an agreement, we will be happy to talk with you to discuss options and minimize any disruption in care.

Can I change my child’s insurance?

MMA participants should also know that there are two times a year when you can change plans:
  1. In the first 120 days after you enroll
  2. Once a year, during a 60-day period at the anniversary of your 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.”

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 encourage you to call Sunshine Health with specific questions about coverage.
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